Abstract
Our objective was to compare monofilament and multifilament tapes positioned without tension at the midurethra for postoperative complications and cure rate. One hundred patients with stress urinary incontinence were randomly allocated into two study groups. Using identical surgical methodology, 50 patients had a monofilament tape inserted at the midurethra using the TVT delivery instrument, and another 50 a multifilament tape using the IVS delivery instrument. The only significant difference between the groups was in the incidence of postoperative urinary retention (p=0.023). Ten patients from the monofilament group required longer than normal (‘normal’ means to the morning of the next day) catheterization, in contrast to only two from the multifilament group. The clinical efficacy of both procedures was equally high. Conclusions were that both tapes appear to be equally effective in the surgical treatment of SUI. The higher incidence of postoperative urinary retention in the monofilament group was most likely caused by the elastic feature of this tape.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- ISD:
-
Intrinsic sphincter deficiency
- PVR:
-
Postvoid residual volume
- SUI:
-
Stress urinary incontinence
- TVT:
-
Tension-free vaginal tape
- UPP:
-
Urethral pressure profile
References
Bidmead J, Cardozo L (2000) Sling techniques in the treatment of genuine stress incontinence. Br J Obstet Gynecol 107:147–156
Choe JM, Kothandapani R, James L, Bowling D (2001) Autologous, cadaveric, and synthetic materials used in sling surgery: comparative biomechanical analysis. Urology 58:482–486
Petros PE, Ulmsten UI (1993) An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol 153[Suppl]:1–93
Petros PE, Ulmsten UI, Papadimitriou J (1990) The autogenic ligament procedure: a technique for planned formation of an artificial neo-ligament. Acta Obstet Gynecol Scand 153[Suppl]:43–51
Keane DP, Sims TJ, Abrams P, Bailey A (1997) Analysis of collagen status in premenopausal nulliparous women with genuine stress incontinence. Br J Obstet Gynecol 104:994–998
Rechberger T, Postawski K, Jakowicki JA, Gunja-Smith Z, Woessner JF (1998) Role of fascial collagen in stress urinary incontinence. Am J Obstet Gynecol 179:1511–1514
Ulmsten U, Johnson P, Rezapour M (1999) A three-year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence. Br J Obstet Gynecol 106:345–350
Petros P (1999) Medium-term follow-up of the Intravaginal Slingplasty operation indicates minimal deterioration of urinary continence with time. Aust NZ J Obstet Gynecol 39:354–356
Gaudenz R (1979) A questionnaire with a new urge-score and stress-score for the evaluation of female urinary incontinence. Geburtsh Frauenheilkd 39:784–792
Ulmsten U, Henriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J 7:81–86
Adamiak A, Milart P, Skorupski P et al. (2002) The efficacy and safety of the tension-free vaginal tape procedure do not depend on the method of analgesia. Eur Urol 42:29–32
Tincello DG, Alfirevic Z (2002) Important clinical outcomes in urogynaecology: views of of patients, nurses and medical staff. Int Urogynecol J 13:96–98
Wang AC (2000) An assessment of the early surgical outcome and urodynamic effects of the tension free vaginal tape – TVT. Int Urogynecol J 11:282–284
Lo TS, Wang AC, Horng SG, Liang CC, Soong YK (2001) Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure – TVT. Acta Obstet Gynecol Scand 80:65–70
Dietz HP, Vancaillie P, Svehla M, Walsh W, Steensma AB, Vancaillie TG (2001) Mechanical properties of implant materials used in incontinence surgery. International Continence Society 31st Annual Meeting. Seoul, Korea, 18–21 September (abstract)
Klinge U, Klosterhalfen B, Müller M, Öttinger AP, Schumpleick V (1998) Shrinking of polypropylene mesh in vivo: an experimental study in dogs. Eur J Surg 164:965–969
Acknowledgments
This paper was supported by KBN grant no.: 6 P05E 028 21.
Author information
Authors and Affiliations
Corresponding author
Additional information
Editorial Comment: For many surgeons, the TVT sling has become the standard of care for the treatment of stress urinary incontinence. Since its introduction less than 10 years ago, TVT has become one of the best-studied procedures in gynecology, with many papers demonstrating its consistent efficacy and safety. This paper demonstrates the efficacy and safety of two minimally invasive slings: the original TVT sling, and the IVS procedure. The basic procedure is nearly identical for these two operations, including minimal paraurethral dissection and midurethral placement of a synthetic sling. The main difference is the physical properties of the polypropylene mesh. TVT is a monofilament mesh that has elastic properties. This accounts for its Velcro-like ability to bind to surrounding tissues, which obviates the need to suture the mesh to the rectus fascia. The IVS device utilizes a multifilament weave, which has minimal elasticity and does not bind firmly to the surrounding tissues. The authors demonstrate comparable efficacy and safety, with a significantly higher rate of urinary retention in the TVT group. Larger studies are needed to determine whether this finding is consistent and of clinical significance.
Rights and permissions
About this article
Cite this article
Rechberger, T., Rzeźniczuk, K., Skorupski, P. et al. A randomized comparison between monofilament and multifilament tapes for stress incontinence surgery. Int Urogynecol J 14, 432–436 (2003). https://doi.org/10.1007/s00192-003-1104-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-003-1104-x