SONOGRAPHIC SLING POSITION AND CURE RATE 10-YEARS AFTER TVT-O PROCEDURE
TAMMAA1, S. HÓLBFER 1, K. TAMUSSINO 2, P. LOZANO 3, B. MAIER 1, D. ULRICH 4;
1Gynecology, WilhelminenHosp., Vienna, Austria, 2Med. Univ. of Graz, Graz, Austria, 3WilhelminenHosp., Vienna, Austria, 4Med. Univ. Graz, Graz, Austria.
Objective: We examined the position of the TVT-O sling 10 years postoperatively and its effect on outcome.
Methods: A total of 124 patients received a TVT-O sling at two centers in 2004 and 2005 and were invited for retrospective follow-up. The position of the sling has been described by perineal ultrasound relative to the bladder neck and the lower margin of the symphysis pubis at rest and on Valsalva maneuver. Objective cure was defined as a negative cough stress test at 300 ml. Subjects completed the Kings´ Health Questionnaire (KHQ), Incontinence Outcome Questionnaire (IOQ), Female Sexual Function Index Questionnaire (FSFI) and the Patient Global Impression of Improvement score (PGII).
Results: After ten years we could reach 57% (78/124) for clinical follow-up assessment. 11(14%) had undergone reoperation due to recurrent or persistent SUI or voiding dysfunction and were excluded, leaving 67 patients for analysis of the purpose of the study. Subjective and objective cure rate was 67% (45/67) and 77% (52/67), respectively. Distance means from the bladder neck to the proximal edge of the tape (BNTD) were significantly higher in the objectively cured women. The absolute distance between tape and urethra (TUD) was significantly higher in objective and subjective cured vs. objectively and subjectively not cured patients. The position of the tape in the middle third of the urethra can serve as a predictor for objective and subjective cure, whereas all tapes >5mm distant from the urethra were associated with failure. No significant differences could be found for tape position regarding OAB symptoms. Objectively and subjectively cured women showed to have significantly better scores in KHQ, IOQ and PGII. FSFI scores in the FSFI questionnaire showed no significant differences, except for the domain lubrication, which was worse in the subjectively failure Group.
Conclusions: Tape position in the middle third of the urethra is associated with significant higher success, whereas a distance >5mm to the urethra is associated with incontinence. The good visibility and easy at hand availability predestines ultrasound as an ideal tool for evaluation of the tape position. Ultrasound is essential for postoperative workup of patients with unsatisfying results after suburethral sling operation.