TVT-O for the Treatment of Female Stress Urinary Incontinence: Results of a Prospective Study after a 3-Year Minimum Follow-Up

in European Urology (2008), 53(2), 401-8

OBJECTIVES: Medium-term results of transobturator tapes for the treatment of female stress urinary incontinence (SUI) are largely unknown. We analyzed the 3-yr results of a prospective, observational ... [more ▼]

OBJECTIVES: Medium-term results of transobturator tapes for the treatment of female stress urinary incontinence (SUI) are largely unknown. We analyzed the 3-yr results of a prospective, observational study designed to evaluate the safety and efficacy of the TVT-O procedure. METHODS: Preoperative and postoperative evaluations included physical examination, uroflowmetry and postvoid residual (PVR) measurement, and urinary symptoms and quality of life (QoL) questionnaires. Data were compared by means of the Wilcoxon matched pairs test. RESULTS: Between March 2003 and December 2003, 102 consecutive patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria underwent the TVT-O procedure; the latter was associated with pelvic organ prolapse treatment in 16 patients (15.7%). Three-year minimum follow-up (median, 40 mo) was available for 91 patients (89.2%). No erosion or persistent pain was noted. Four patients required tape release or section. Disappearance and improvement of SUI were observed in 88.4% and 9.3% of the patients, respectively. These cure rates were similar to those obtained 1 yr after the operation (p=0.55). Frequency and urge symptoms were improved at 3 yr (p<0.005). Whereas maximum flow rates were somewhat decreased (p=0.01), the severity of obstructive symptoms and PVR volumes were not statistically different (p=0.11 and p=0.32, respectively). Incontinence severity and QoL scale scores were largely better than preoperative ones (p<0.001) and did not differ from those reported at 1 yr (p=0.15 and p=0.08, respectively). CONCLUSIONS: The TVT-O procedure is a safe and efficient treatment of female SUI, with maintenance of high cure rates after a 3-yr minimum follow-up. [less ▲]

The inside-out trans-obturator sling: a novel surgical technique for the treatment of male urinary incontinence.

in European Urology (2008), 54(5), 1051-65

OBJECTIVES: To describe a new sling procedure for treating stress urinary incontinence (SUI) after radical prostatectomy (RP) and prospectively evaluate its short-term safety and efficacy. METHODS: The ... [more ▼]

OBJECTIVES: To describe a new sling procedure for treating stress urinary incontinence (SUI) after radical prostatectomy (RP) and prospectively evaluate its short-term safety and efficacy. METHODS: The sling technique uses specific instruments and a polypropylene mesh with two arms that are passed inside to outside through the obturator foramens, pulled for compressing the bulbar urethra upward, and tied to each other across the midline. Patients with detrusor overactivity were excluded. Baseline and follow-up evaluations included uroflowmetry and continence and quality of life (QoL) questionnaires. Cure was defined by no pad use and improvement by a number of pads/d <or=2 and reduced by at least 50%. Complications were recorded. RESULTS: From April 2006 through February 2007, 20 consecutive patients suffering from post-RP SUI underwent the sling procedure using the same operative protocol. Preoperatively, 3 (15%), 11 (55%), and 6 (25%) patients were using 2, 3-5, and >5pads/d, respectively. The procedure was preceded by an endoscopic urethrotomy in four patients. No perioperative complication was noted; three patients required suprapubic catheterization. At 6 mo, nine (45%) patients were cured and eight others (40%) were improved (1pad/d). QoL was significantly enhanced and 80% of patients were moderately to completely satisfied with the procedure. Preoperative and postoperative maximum flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain, or neurologic complications were observed. CONCLUSIONS: The inside-out trans-obturator sling procedure appears to be safe and efficient at short term. Further studies are warranted to determine long-term outcome. [less ▲]

The inside-out trans-obturator sling: A novel surgical technique for the treatment of male urinary incontinence

in European Urology (2007)

OBJECTIVES: To describe a new sling procedure for treating stress urinary incontinence (SUI) after radical prostatectomy (RP) and prospectively evaluate its short-term safety and efficacy. METHODS: The ... [more ▼]

OBJECTIVES: To describe a new sling procedure for treating stress urinary incontinence (SUI) after radical prostatectomy (RP) and prospectively evaluate its short-term safety and efficacy. METHODS: The sling technique uses specific instruments and a polypropylene mesh with two arms that are passed inside to outside through the obturator foramens, pulled for compressing the bulbar urethra upward, and tied to each other across the midline. Patients with detrusor overactivity were excluded. Baseline and follow-up evaluations included uroflowmetry and continence and quality of life (QoL) questionnaires. Cure was defined by no pad use and improvement by a number of pads/d </=2 and reduced by at least 50%. Complications were recorded. RESULTS: From April 2006 through February 2007, 20 consecutive patients suffering from post-RP SUI underwent the sling procedure using the same operative protocol. Preoperatively, 3 (15%), 11 (55%), and 6 (25%) patients were using 2, 3-5, and >5pads/d, respectively. The procedure was preceded by an endoscopic urethrotomy in four patients. No perioperative complication was noted; three patients required suprapubic catheterization. At 6 mo, nine (45%) patients were cured and eight others (40%) were improved (1pad/d). QoL was significantly enhanced and 80% of patients were moderately to completely satisfied with the procedure. Preoperative and postoperative maximum flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain, or neurologic complications were observed. CONCLUSIONS: The inside-out trans-obturator sling procedure appears to be safe and efficient at short term. Further studies are warranted to determine long-term outcome. [less ▲]

Cure d’incontinence urinaire masculine par prothèse sous-bulbaire trans-obturatrice in-out

Conference (2007)

Development of urine-based DNA methylation assay for prostate cancer screening

Poster (2007)

Introduction: The best outcome for patients with prostate cancer (PCa) is seen for those treated at an early stage of the disease. A digital rectal examination (DRE) and the measurement of serum prostate ... [more ▼]

Introduction: The best outcome for patients with prostate cancer (PCa) is seen for those treated at an early stage of the disease. A digital rectal examination (DRE) and the measurement of serum prostate specific antigen (PSA) levels are the current standards for PCa early detection. However, serum PSA testing lacks both sensitivity and specificity, and core biopsies frequently fail to identify small foci of PCa. The availability of non-invasive diagnostic molecular tests that could allow for a more precise identification of malignant prostate cells in asymptomatic men would be of great clinical value to improve PCa diagnosis. Study design: 114 men scheduled to undergo a prostate biopsy were enrolled in the study. The biopsies were triggered either by an abnormally high PSA value or by suspicious findings on DRE. Patients with other known or suspected urinary malignancy were excluded from the study. Morning, post-prostate massage and post-biopsy urine samples were collected from all individuals. The main goals of this study were a) to determine if prostate massage can improve the prostate DNA quantity compared to urine collected in the morning or after biopsy, and b) to evaluate the methylation status of a gene panel in urine samples from subjects with cancer found in prostate biopsy tissue cores versus subjects without cancer. Methods: Gene promoter methylation is associated with prostate cancer and has been successfully used for the molecular detection of neoplasia in urine. We have developed real-time methylation specific PCR assays to define the methylation status of several genes. Results: Median age of the patients was 65 years (range 48-85). PCa was found in 51% of the patients. Histological diagnosis of the biopsies was compared to methylation results in urine from 102 samples (89% success rate due low DNA yields for 12 samples). The comparison between different urine sampling techniques showed that prostate massage is needed. The best results were obtained in post massage urine samples with a combination of GSTP1, p14, p16, RARβ2 and RASSF1A resulting in a sensitivity of 74% and a specificity of 75%. Future: A multiplex assay using the Cepheid SmartCycler™ II platform is under development. Further studies are in progress to validate the assay across multiple centers. [less ▲]

Inside out transobturator vaginal tape for the treatment of female stress urinary incontinence: Interim results of a prospective study after a 1-year minimum followup

in Journal of Urology (The) (2006), 175(6), 2191-2195

Purpose: We analyzed the results of a prospective, observational trial designed to assess the safety and efficacy of the TVT-O procedure for female SUI. Materials and Methods: Preoperative and ... [more ▼]

Purpose: We analyzed the results of a prospective, observational trial designed to assess the safety and efficacy of the TVT-O procedure for female SUI. Materials and Methods: Preoperative and postoperative evaluations included physical examination, and urinary symptom and quality of life scale questionnaires. Results: Between March 2003 and December 2004, 253 patients with clinical and urodynamic diagnoses of SUI who fulfilled inclusion and exclusion criteria were enrolled in the trial and underwent the TVT-O procedure. No significant intraoperative complications were observed. One-year minimum followup was available on 99 of the initial 102 patients, of whom 16 had undergone concomitant pelvic organ prolapse surgical treatment. The SUI complete cure rate was 91%. No patient had vaginal or urethral erosion. Four patients required tape release or section. Frequency and urge symptoms improved after the operation (p < 0.001). The severity of obstructive symptoms slightly increased postoperatively in the group of patients who did not undergo associated pelvic organ prolapse treatment (p < 0.05), while maximum flow rates somewhat decreased (p < 0.001) and post-void residual urine volumes somewhat increased (p < 0.005). Most patients reported a significant decrease in incontinence severity and improvement in quality of life (p < 0.0001). Conclusions: The results of this study, which suggest that the TVT-O procedure is a safe and efficient surgical treatment for female SUI, warrant further comparative evaluation of this procedure with retropubic and outside in transobturator approaches in appropriately designed, prospective, randomized trials. [less ▲]

Re: Transobturator surgery of urinary incontinence in women by means of transobturator procedures: Outside in or inside out? Comparative anatomical study. By Spinosa J.P., Dubuis P.Y., Riederer B. Prog. Urol., 2005, 15 (4):700-706

in Progrès en Urologie (2005), 15(6), 1161-1162

Lipomatose pelvienne associee a une cystite glandulaire: rapport de deux cas

in Progrès en Urologie (2005), 15(1), 81-4

The authors report two cases of pelvic lipomatosis associated with glandular cystitis. This is a rare disease with variable and nonspecific clinical features. Complementary investigations useful for the ... [more ▼]

The authors report two cases of pelvic lipomatosis associated with glandular cystitis. This is a rare disease with variable and nonspecific clinical features. Complementary investigations useful for the diagnosis of pelvic lipomatosis are CT and especially MRI, intravenous urography and biopsies. The clinical features, radiological findings and therapeutic approach are discussed in the light of a review of the literature. [less ▲]

Le TVT transobturateur de dedans en dehors (TVT-O): Considérations anatomiques

Conference (2005)

New surgical technique for treatment of stress urinary incontinence TVT-Obturator: New developments and results

in Surgical Technology International (2005), 14

A new surgical technique, the inside-out transobturator tension-free urethral suspension (TVT-Obturator), has been developed for treatment of women suffering from stress urinary incontinence (SUI). This ... [more ▼]

A new surgical technique, the inside-out transobturator tension-free urethral suspension (TVT-Obturator), has been developed for treatment of women suffering from stress urinary incontinence (SUI). This simple procedure uses specifically designed surgical instruments to allow the accurate passage of a synthetic tape from underneath the urethra, through the obturator foramens, toward the thigh folds, with the tape being positioned without tension under the junction between mid and distal urethra. Cadaver dissection studies have demonstrated that the anatomical trajectory of the tape in tissues is strictly perineal and consistently coursed away from neighboring neurovascular structures, including the obturator, femoral, and saphenous nerves and vessels, as well as the pudendal nerve. Consequently, as opposed to retropubic sling systems, no perioperative cystoscopy is required because the TVT-O tape does not enter the pelvic region at any time during the procedure. These anatomical data, which suggest the TVT-O technique is safe, have been corroborated by initial clinical experience. Our feasibility and ongoing efficacy studies have shown that TVT-O is associated with a low incidence of perioperative and postoperative complications. In our current series of more than 500 consecutive patients treated with TVT-O, no injury to the bladder or urethra was encountered and no perineal or obturator hematoma, heavy bleeding, or neurological complication was observed. Medium-term results have suggested that TVT-O is as efficient as retropubic tension-free slings for treatment of female SUI, with +/-90% complete cure rates after one-year follow up. [less ▲]