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See detailThe inside-out transobturator sling for the surgical treatment of post-radical prostatectomy urinary incontinence: Short term results of a prospective study
Waltregny, David ULg; Leruth, Julie ULg; de Leval, Jean ULg

in European Urology Supplements (2009), 4(8), 336

Introduction and Objective: To prospectively evaluate the short-term safety and efficacy of a new transobturator sling procedure for treating post-radical prostatectomy (RP) stress urinary incontinence ... [more ▼]

Introduction and Objective: To prospectively evaluate the short-term safety and efficacy of a new transobturator sling procedure for treating post-radical prostatectomy (RP) stress urinary incontinence (SUI). Methods: The sling technique uses specific instruments and a polypropylene mesh with 2 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. Inclusion criteria were clinically and urodynamically demonstrated SUI, positive bulbar compression test, and signed informed consent. Patients with detrusor overactivity were excluded. Baseline and followup 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 04/2006 through 10/2008, 70 consecutive patients who fulfilled inclusion and exclusion criteria underwent the sling procedure using the same operative protocol. As of October 2008, 55 and 35 patients who consecutively underwent the sling procedure were expected to have a minimum followup of 6 months and 1 year, respectively. Preoperatively, 13 (24%), 25 (45%), and 17 (31%) patients were using 2, 3 to 5, and >5 pads/d, respectively. Nine and 6 patients had undergone prior surgery for SUI and/or previous pelvic irradiation, respectively. The sling procedure was preceded by an endoscopic urethrotomy in 5 (9%) patients. No perioperative complication was noted. Seven (13%) patients required suprapubic catheterization; normal voiding resumed in all 7 patients except 1 who underwent urinary diversion for radiation-induced complete anastomotic stricture. Six-month and 1-year minimum followup was available on 51 (93%) and 33 (94%) patients, respectively (Table 1). Of note, at 6 months, among the 17 patients with preoperative severe incontinence (> 5 pads/day), 9 (53%) patients were cured and 6 others (35%) were improved (1 pad/d). Overall, QoL was significantly enhanced and 85% patients were moderately to completely satisfied with the procedure. Preoperative and postoperative max flow rate and postvoid residual values were not statistically different. No sling infection, urethra erosion, persistent pain or neurological complication was observed. No sling was withdrawn or cut. Conclusions: The inside-out transobturator sling procedure appears to be safe and efficient at short term. [less ▲]

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See detailInside-out Transobturator Vaginal Tape (TVT-O): one-year results of a prospective study
Waltregny, David ULg; Reul, Olivier ULg; Keppenne, Véronique ULg et al

in European Urology Supplements (2005), 4(3), 1653

Title Inside-out transobturator vaginal tape (TVT-O): One-year results of a prospective study Introduction and Objectives The aim of this study was to prospectively assess the efficacy of a new surgical ... [more ▼]

Title Inside-out transobturator vaginal tape (TVT-O): One-year results of a prospective study Introduction and Objectives The aim of this study was to prospectively assess the efficacy of a new surgical technique, the inside-out transobturator vaginal tape (TVT-O), for the treatment of female stress urinary incontinence (SUI). Study design, materials and methods From 03/2003 through 10/2003, a TVT-O tape was inserted in 83 consecutive patients with clinical evidence of SUI. Preoperative evaluation included complete history, physical examination, urodynamics, urine analysis, and cystoscopy. None of the patients presented the following exclusion criteria: post-void residual (PVR) >100 cc, detrusor overactivity or acontractility, pregnancy, neurological pathology, active urinary or vaginal infection, age >85 years, negative stress test, and maximum cystometric capacity <300 mL. Post-operative evaluation was carried out using symptom scoring and quality of life (QoL) questionnaires, visual analog scales, physical examination, uroflowmetry, and PVR measurement. Cure was defined as no leakage based on both symptom scale scoring and physical examination. Improvement was defined as ≥50% decrease in symptoms based on the questionnaire’s results. Results Mean age of the patients was 61 years. The TVT-O procedure was associated with pelvic organ prolapse cure in 15 patients (18%). Follow-up time was ≥12 months in all women (mean = 13.6); 3 patients were lost to follow-up. No significant blood loss (≥100 cc), vaginal wall, urethral, or bladder perforation was encountered. No hematoma, vaginal or urethral erosion, or neurological complication was observed. No patient complained of persistent pain. At the latest follow-up visit, max flow rate was ≥10 mL/sec and PVR was <100 cc in 90% and 94% patients, respectively. Two patients underwent an immediate tape release procedure while the tape was sectioned in 2 other patients for retention and/or urgency associated with obstruction. Sixty eight patients (85%) were cured of their SUI while 9 patients (11%) were improved. Urgency questionnaire’s results showed that 5 (5/46) patients developed de novo urgency. Twenty and 14 out of the 34 patients with preoperative urge symptoms reported either disappearance or no change of urgency, respectively. Obstruction symptoms appeared or worsened in 3 patients and were unchanged or decreased in all other patients. Analysis of the incontinence visual analog and QoL scale scores showed that the majority of patients reported disappearance of incontinence together with significant improvement of their QoL. Conclusions The one-year results of this study suggest that TVT-O is associated with a low incidence of peri- and post-operative complications and high objective and subjective SUI cure rates. [less ▲]

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See detailNovel surgical technique for the treatment of female urinary incontinence: Transobturator vaginal tape inside-out
de Leval, Jean ULg; Bonnet, Pierre ULg; Reul, Olivier ULg et al

in European Urology Supplements (2004, February), 3(2), 226

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