[Show abstract][Hide abstract] ABSTRACT: We reviewed articles in the PubMed database which describe the results and outcome of a repeat midurethral synthetic sling
(MUS), known as tension-free vaginal tape (TVT), or transobturator tape/tension-free vaginal tape obturator for prior MUS
failure in patients who presented with persistent or recurrent stress urinary incontinence (SUI). We combined or separated
the keywords “TVT,” “failure,” “repeat TVT,” and “recurrent/persistent SUI.” The search was limited by publication data from
2000 to 2010, humans, female, and English text. A repeat TVT procedure treating prior TVT failure showed success rates ranging
from 70% to 90%. The outcomes showed no significant differences between a repeat retropubic route or transobturator route.
A repeat MUS procedure for persistent or recurrent stress urinary incontinence is a reliable option for patients with prior
No preview · Article · Feb 2012 · Gynecological Surgery
[Show abstract][Hide abstract] ABSTRACT: This study was conducted to evaluate the effectiveness of self-fashioned Gynemesh for the concomitant treatment of urinary incontinence and anterior vaginal wall prolapse, and the factors involved in mesh erosion.
From March 2004 to September 2006, 65 women with urinary incontinence, with or without pelvic organ prolapse or prior surgery for prolapse or incontinence, were recruited for this study. A self-fashioned Gynemesh was used for the concomitant treatment of urinary incontinence and anterior vaginal wall prolapse. Patients in this study underwent suburethral slingplasty and/or concomitant pelvic reconstructive operations. A general linear model univariate analysis was performed to assess the relationships between mesh erosion and various variables.
The mean postoperative follow-up was 33 months. Those patients with anterior wall prolapse presented as completely cured postoperatively. The cure rate for urinary incontinence was 80%, and the improvement rate was 17%. Vaginal mesh erosion was discovered in four patients (6%) during the postoperative follow-up. These four patients remained continent after the removal of the eroded mesh. The interactive effects for mesh erosion by a general linear model analysis were menopausal women with advanced anterior vaginal wall prolapse (p < 0.05) and women with advanced anterior vaginal wall prolapse with concomitant sacrospinous ligament fixation (p < 0.05).
We found that using self-fashioned Gynemesh for tension-free suburethral and anterior vaginal slingplasty provided a high success rate (97%) in the 3 years of follow-up. Mechanical rejection may be one of the causes of vaginal mesh erosion.
No preview · Article · Mar 2009 · Taiwanese journal of obstetrics & gynecology
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to compare the pre- and postoperative urodynamic findings of the suburethral autologous rectus fascial sling procedure and to determine patient satisfaction with the procedure by telephone interviews. Eight-four female patients with urodynamic stress incontinence completed a multi-channel urodynamic study and pad test before and after the operation. Subjective and objective satisfaction were also recorded. Significant changes were noted in the stress maximal urethral closure pressure, pad test, voided volume, and peak flow rate (P < 0.05). The success rate was about 94%, and subjective satisfaction was about 72%. The most common complication was transient urinary tract infections. The suburethral sling resolved 50% of detrusor overactivity (DO), but de novo DO was 24%. The procedure combined with anterior colporrhaphy corrected or improved 97% of anterior vaginal wall prolapses (> or =stage II). This retrospective study demonstrates that suburethral autologous facial slingplasty has a high cure rate, high patient satisfaction, and is a less complicated procedure. It can also correct and prevent a recurrence of anterior vaginal wall prolapse when combined with anterior colporrhaphy.
No preview · Article · Aug 2008 · International Urogynecology Journal
[Show abstract][Hide abstract] ABSTRACT: The role of Burch colposuspension as the primary surgical treatment of stress urinary incontinence has been challenged by less invasive new surgical methods. The aim of this study was to evaluate the long-term results of Burch colposuspension in terms of subjective self-reported outcomes. Between 1993 and 1997, 159 women who underwent Burch colposuspension as the first operation for treating urodynamic stress incontinence were recruited for this study. We recorded the findings of preoperative and postoperative urodynamic studies and early postoperative complications or adverse effects related to the operation. In 2005, after a median follow-up of 10 years, telephone interviews were carried out and 152 (95.5%) women responded. Two main questions were asked of these women to evaluate the overall impression of improvement after the operation. Eighty-four (55.3%) women were dry according to their subjective reports, 55 (36.2%) women had improved, and 13 (8.5%) women had failed after an 8- to 12-year follow-up. One hundred and twenty-five (82.2%) women were satisfied with the outcome of the operation and 27 (17.8%) women were not. Among these 27 women, 16 (59.2%) women complained of urinary frequency and 9 (33.3%) women complained of urinary urgency as the reasons for their dissatisfaction. Our long-term subjective outcomes revealed that Burch colposuspension is an effective alternative surgery for urodynamic proven stress incontinence.
No preview · Article · Sep 2007 · International Urogynecology Journal
[Show abstract][Hide abstract] ABSTRACT: To evaluate the different effects on urethral pressure profilometry (UPP) in pubovaginal slingplasty (PVS) and modified Burch colposuspension (MBC) procedures.
This was a descriptive study of urodynamic parameters and urethral pressure profilometry. A total of 63 patients with successful anti-incontinence surgery were recruited for this study. Thirty-eight women had received MBC before 1998, to stabilize the bladder neck and the anterior vaginal wall. Twenty-five women had undergone autologous PVS to elevate the backstop effect on the proximal urethra between 1998 and 2000. All patients were followed-up for at least 24 months after surgery.
The mean age of patients in the PVS group was 52.5 years (range, 32-70 years), and 45.5 years (range, 31-61 years) in the MBC group. Age and parity were not significantly different between the two groups. The pressure transmission ratio (PTR) of the urethra increased significantly in both groups during the postoperative evaluation. Patients who had the MBC procedure showed an increased PTR at quarter (Q) Q1, Q2, and Q3 of the urethra. However, in the PVS group, the PTR increased only at Q3. The urethral closure pressure elevated significantly after MBC, but there were no significant changes after PVS.
Our results indicate that different effects on UPP are evident in the PVS and MBC procedures. These two procedures should be considered in different anti-incontinence effect.
No preview · Article · Jul 2006 · Taiwanese journal of obstetrics & gynecology
[Show abstract][Hide abstract] ABSTRACT: To investigate early postoperative complications of Burch colposuspension and the risk factors that may be associated with failure.
We retrospectively reviewed the chart records of all patients who underwent Burch colposuspension from October 1997 to September 2002. Indications for colposuspension included urodynamic stress incontinence with bladder neck hypermobility and adequate vaginal capacity. The occurrence of early postoperative complications related to the operation was documented. Subjective failure of the operation was defined as patient dissatisfaction and/or persistent urinary leakage. Chi-square test or Fisher's exact test was used to determine the association among risk factors, early postoperative complications, and the failure rate of Burch colposuspension.
A total of 258 patients (92.5%) reported satisfaction with the surgical outcome. The age, parity, menopausal status, use of hormone replacement therapy, previous hysterectomy, and occurrence of early postoperative complications did not significantly influence the failure rate.
Our results demonstrate that Burch colposuspension is an effective and, according to our patients, highly satisfactory procedure for the treatment of urodynamic stress incontinence.
No preview · Article · Apr 2006 · Taiwanese journal of obstetrics & gynecology
[Show abstract][Hide abstract] ABSTRACT: Problems relating to the erosion of sling material, through either the vagina or the urethra, have been encountered with almost all kinds of synthetic sling materials. We present four unusual cases of women using different synthetic materials and the complications that occurred. The biopsies were examined histologically and analyzed for collagen and inflammatory reactions. Four patients who underwent suburethral slingplasty previously with different sling materials required surgical management for complications, including one intravesical Ethibond migration, vaginal mucosal mesh erosion in two patients, and one proximal urethral overcorrection with intravesical erosion. We reviewed the literature regarding the amount of mesh erosion and connective tissue reaction with synthetic materials. The efficiency of mesh removal was assessed. The four patients maintained urinary continence after urethrolysis and removal of the mesh. Fibrosis and severe inflammatory reactions were found in the connective tissue adjacent to the mesh as well as the Prolene mesh. Technically, it would be easier to remove the graft of patch sling if rejection or erosion occurs.
No preview · Article · Apr 2005 · International Urogynecology Journal