Abstract
The aim of this study is to evaluate the efficacy and feasibility of concomitant pelvic reconstructive surgery with tension-free vaginal tape (TVT) procedure to treat pelvic organ prolapse women with urodynamic stress incontinence (USI) or occult USI. Seventy-five women with pelvic organ prolapse and diagnosed as USI or occult USI were enrolled in this study. All patients with USI or occult USI underwent TVT treatment under general anesthesia, combined with transvaginal total hysterectomy (VTH), anterior–posterior colporrhaphy (APC), and/or right sacrospinous ligament suspension (SSS) reconstructive surgeries. The subjective assessment was evaluated by using a visual analog scale (VAS) score and a urinary symptomatic questionnaire. The objective assessment was carried out with a 1-h pad test, cough stress test, and urodynamic examination. Of the 75 patients, 35 patients with grade III uterine prolapse underwent VTH and APC, 30 patients with grade IV uterine prolapse underwent VTH, SSS, and APC, and the other 10 patients who had previous hysterectomy with total vaginal vault prolapse underwent SSS and APC. The mean follow-up interval was 25 months (12–42 months). The mean hospitalization was 5.9 days and the mean catheterization time was 3.8 days. The subjective success rate for the treatment of urine incontinence was 88%, and the objective complete cure rate was 84%. The rate of postoperative complications with persistent urinary urgency, de novo detrusor overactivity, dysfunctional voiding, and tape erosion were 50, 8, 12, and 1.3%, respectively. There were no bladder perforations during the TVT procedure and no perioperative complications requiring conversion to laparotomy. Pelvic organ prolapse women with USI or occult USI can be treated by reconstructive surgeries combined with a TVT procedure to treat and prevent postoperative USI.
Similar content being viewed by others
References
Bump RC, Fantl JA, Hurt WG (1998) The mechanism of urinary continence in women with severe uterovaginal prolapse: results of barrier studies. Obstet Gynecol 72(3 Pt 1):291–295
Bergman A, Koonings PP, Ballard CA (1988) Predicting postoperative urinary incontinence development in women undergoing operation for genitourinary prolapse. Am J Obstet Gynecol 158(5):1171–1175
Drutz HP, Alnaif B (1998) Surgical management of pelvic organ prolapse and stress urinary incontinence. Clin Obstet Gynecol 41(3):786–793
Klutke JJ, Ramos S (2000) Urodynamic outcome after surgery for severe prolapse and potential stress incontinence. Am J Obstet Gynecol 182(6):1378–1381
Beck RP, McCormick S, Nordstrom L (1991) A 25-year experience with 519 anterior colporrhaphy procedures. Obstet Gynecol 78(6):1011–1018
Borstad E, Rud T (1989) The risk of developing urinary stress-incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study. Acta Obstet Gynecol Scand 68(6):545–549
Harris TA, Bent AE (1990) Genital prolapse with and without urinary incontinence. J Reprod Med 35(8):792–798
Gardy M, Kozminski M, DeLancey J, Elkins T, McGuire EJ (1991) Stress incontinence and cystoceles. J Urol 145(6):1211–1213
Chaikin DC, Groutz A, Blaivas JG (2000) Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol 163(2):531–534
Hextall A, Boos K, Cardozo L, Toozs-Hobson P, Anders K, Khullar V (1998) Videocystourethrography with a ring pessary in situ. A clinically useful preoperative investigation for continent women with urogenital prolapse? Int Urogynecol J Pelvic Floor Dysfunct 9(4):205–209
Stach-Lempinen B, Kujansuu E, Laippala P, Metsanoja R (2001) Visual analogue scale, urinary incontinence severity score and 15 D—psychometric testing of three different health-related quality-of-life instruments for urinary incontinent women. Scand J Urol Nephrol 35(6):476–483
Raz S (1996) Raz techniques for anterior vaginal wall repair. In: Raz S (ed) Female urology, 2nd edn. WB Saunders, Los Angeles, pp344–366
International Continence Society (1983) Quantification of urine loss. Fifth Report on the Standardization of Terminology. Acaden, West Germany: International Continence Society
Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL (1997) Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4):501–506
Huang KH, Kung FT, Liang HM, Huang LY, Chang SY (2003) Concomitant surgery with tension-free vaginal tape. Acta Obstet Gynecol Scand 82(10):948–953
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 7:81–85 (see also discussion pp85–86)
Richardson DA, Bent AE, Ostergard DR (1983) The effect of uterovaginal prolapse on urethrovesical pressure dynamics. Am J Obstet Gynecol 146(8):901–905
Borstad E, Rud T (1989) The risk of developing urinary stress-incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study. Acta Obstet Gynecol Scand 68(6):545–549
Chaikin DC, Groutz A, Blaivas JG (2000) Predicting the need for anti-incontinence surgery in continent women undergoing repair of severe urogenital prolapse. J Urol 163(2):531–534
Hextall A, Boos K, Cardozo L, Toozs-Hobson P, Anders K, Khullar V (1998) Videocystourethrography with a ring pessary in situ A clinically useful preoperative investigation for continent women with urogenital prolapse?. Int Urogynecol J Pelvic Floor Dysfunct 9(4):205–209
Gordon D, Groutz A, Wolman I, Lessing JB, David MP (1999) Development of postoperative urinary stress incontinence in clinically continent patients undergoing prophylactic Kelly plication during genitourinary prolapse repair. Neurourol Urodyn 18(3):193–197 (see also discussion pp (197–198)
Groutz A, Gordon D, Wolman I, Jaffa AJ, Kupferminc MJ, David MP, Lessing JB (2000) The use of prophylactic Stamey bladder neck suspension to prevent post-operative stress urinary incontinence in clinically continent women undergoing genitourinary prolapse repair. Neurourol Urodyn 19(6):671–676
Colombo M, Maggioni A, Scalambrino S, Vitobello D, Milani R (1997) Surgery for genitourinary prolapse and stress incontinence: a randomized trial of posterior pubourethral ligament plication and Pereyra suspension. Am J Obstet Gynecol 176(2):337–343
Barnes NM, Dmochowski RR, Park R, Nitti VW (2002) Pubovaginal sling and pelvic prolapse repair in women with occult stress urinary incontinence: effect on postoperative emptying and voiding symptoms. Urology 59(6):856–860
Eriksen BC, Hagen B, Eik-Nes SH, Molne K, Mjolnerod OK, Romslo I (1990) Long-term effectiveness of the Burch colposuspension in female urinary stress incontinence. Acta Obstet Gynecol Scand 69(1):45–50
Alcalay M, Monga A, Stanton SL (1995) Burch colposuspension: a 10–20-year follow-up. Br J Obstet Gynecol 102:740–745
Petros PE, Ulmsten UI (1990) An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl 153:7–31
Nilsson CG (1998) The tension-free vaginal tape procedure (TVT) for treatment of female urinary incontinence. A minimally invasive surgical procedure. Acta Obstet Gynecol Scand Suppl 168:34–37
Ulmsten U, Falconer C, Johnson P, Jomaa M, Lanner L, Nilsson CG, Olsson I (1998) A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J 9:210–213
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 Gynaecol 106:345–350
Kuuva N, Nilsson CG (2002) A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 81(1):72–77
Klutke C, Siegel S, Carlin B, Paszkiewicz E, Kirkemo A, Klutke J (2001) Urinary retention after tension-free vaginal tape procedure: incidence and treatment. Urology 58(5):697–701
Meschia M, Pifarotti P, Bernasconi F, Guercio E, Maffiolini M, Magatti F, Spreafico L (2001) Tension-free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 12(Suppl 2):S24–S27
Ulmsten U, Falconer C, Johnson P, Jomaa M, Lanner L, Nilsson CG, Olsson I (1998) A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 9(4):210–213
Gordon D, Gold RS, Pauzner D, Lessing JB, Groutz A (2001) Combined genitourinary prolapse repair and prophylactic tension-free vaginal tape in women with severe prolapse and occult stress urinary incontinence: preliminary results. Urology 58(4):547–550
Chaliha C, Stanton SL (2000) Urethral sphincter incontinence. In: Stanton SL, Ash KM (eds) Clinical urogynaecology. Harcourt, Spain, 214pp
Partoll LM (2002) Efficacy of tension-free vaginal tape with other pelvic reconstructive surgery. Am J Obstet Gynecol 186(6):1292–1295 (see also discussion pp1295–1298)
Lo TS, Chang TC, Chao AS, Chou HH, Tseng LH, Liang CC (2003) Tension-free vaginal tape procedure on genuine stress incontinent women with coexisting genital prolapse. Acta Obstet Gynecol Scand 82(11):1049–1053
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Huang, KH., Kung, FT., Liang, HM. et al. Concomitant pelvic organ prolapse surgery with TVT procedure. Int Urogynecol J 17, 60–65 (2006). https://doi.org/10.1007/s00192-005-1337-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-005-1337-y