Surgeon-tailored polypropylene mesh as a tension-free vaginal tape-obturator versus original TVT-O for the treatment of female stress urinary incontinence: a long-term comparative study
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Introduction and hypothesis
The objective of the study was to compare the safety and efficacy of surgeon-tailored polypropylene mesh (STM) through tension-free vaginal tape-obturator (TVT-O) versus original TVT-O in the treatment of stress urinary incontinence (SUI) aiming to decrease the cost of treatment. This is important in developing countries due to limited health care resources.
A retrospective cohort study was done at the Urology and Gynecology Departments (dual-center), Cairo University from May 2007 to June 2010. Women evaluated by cough stress test, Stress and Urge Incontinence and Quality of Life Questionnaire (SUIQQ), maximum flow rate (Qmax), and abdominal leak point pressure (ALPP) with follow-up for at least 48 months were included. Patients with post-void residual urine > 100 ml, bladder capacity < 300 ml, or impaired compliance were excluded. The effect of different factors on outcome was compared between both groups pre- and postoperatively using the paired t, Wilcoxon signed rank, McNemar, chi-square, Fisher’s exact, independent t, or Mann–Whitney tests.
STM and TVT-O were inserted in 79 and 66 women, respectively. Intrinsic sphincter deficiency, ALPP, previous surgeries, associated urgency, urgency urinary incontinence (UUI), and prolapse were comparable in both groups. Operative duration was longer in STM by 10 min. No significant difference was found between both groups in complications (p = 0.462), cure (p = 0.654), and different indices of SUIQQ. In STM, 74 (93 %) were cured and 3 (4 %) improved, while SUI persisted in 2 (2 %) patients. In TVT-O, 59 (89 %) were cured and 4 (6 %) improved, while failure was detected in 3 (4 %) patients.
The 5-year outcome is comparable between STM and TVT-O. Furthermore, STM is more economical due to our resterilizable modified helical passers and the cheap polypropylene mesh.
KeywordsFemale stress urinary incontinence Surgeon-tailored mesh Polypropylene mesh TVT-O, TOT Cost
Abdominal leak point pressure
Cough stress test
Intrinsic sphincter deficiency
Mixed urinary incontinence
- Pdet Qmax
Detrusor pressure at maximum flow rate
Post-void residual urine
Maximum flow rate
Quality of life
Stress urinary incontinence
Stress and Urge Incontinence and Quality of Life Questionnaire
Transobturator vaginal tape outside-in
Tension-free vaginal tape
Transobturator vaginal tape inside-out
Abdominal and pelvic ultrasound
Urgency urinary incontinence
Randomized controlled trial
Conflicts of interest
M. ElSheemy: protocol development, data collection and analysis, manuscript writing/editing. H. Fathy: protocol development, data collection. A. Hussein: protocol development, data collection. R. ElSergany: protocol development, manuscript editing. E. Hussein: protocol development, data collection.
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