What surgical treatments are available for stress incontinence?

Objectives:

To compare the intraoperative and immediate postoperative performance of the retropubic tension-free vaginal tape (TVT) procedure with that of the transobturator tension-free vaginal tape (TVT-O) procedure as primary treatment for female urinary stress incontinence.

Methods:

Randomized multicenter comparative trial including four university hospitals and three central hospitals in Finland. Assessment preoperatively and 2 months postoperatively included a cough stress test and the following condition-specific quality of life questionnaires: the Urinary Incontinence Severity Score (UISS), the Detrusor Instability Score, the Incontinence ImpactQuestionnaire-Short Form, the Urogenital Distress Inventory-Short Form, and a visual analog scale (VAS). Operation time, theater time, hospital stay, intraoperative and immediate postoperative complications were recorded.

Results:

Of the 273 originally randomized patients, 267 underwent the allocated operation, 136 in the TVT group and 131 in the TVT-O group. No significant differences in objective or subjective cure rates were detected. Patients in the TVT-O group had a significantly longer hospital stay, needed significantly more postoperative opiate analgesia and had significantly more complications than the patients in the TVT group. Patients in both groups had a significant postoperative improvement in quality of life, as indicated by the results of all the questionnaires used, with no difference between the groups.

Conclusion:

The TVT and the TVT-O procedures perform equally in terms of objective and subjective cure. The statistically significant higher complication rate in the TVT-O group is not regarded as clinically significant.

Please click on the required question.

• 1  How is urine produced?
• 2  What is cystitis?
• 3  How prevalent is cystitis?
• 4  What is honeymoon cystitis?
• 5  What are Frequency and nocturia?
• 6  How prevalent are Frequency and nocturia?
• 7  What is urinary incontinence?
• 8  What is stress incontinence of urine?
• 9  What is urgency, urge incontinence and the urge syndrome?
• 10 What causes stress and urge incontinence?
• 11 What is dribbling incontinence?
• 12 How prevalent is urinary incontinence?
• 13 What is the urethral syndrome?
• 14 How can I record my bladder problems and monitor the effects of treatment?
• 15 What simple measures are available to reduce urinary incontinence?
• 16 What are pelvic floor exercises?
• 17 How successful are pelvic floor exercises?
• 18 What is bladder training?
• 19 How effective is bladder training?
• 20 Are there any alternatives to bladder training for urgency symptoms?
• 21 If simple measures do not suffice, what else is available for the treatment of urinary stress incontinence?
• 22 What are urodynamic studies?
• 23 Where can I obtain further information about bladder problems?
• 24 Support Groups.

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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