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Suburethral Sling (TVT) procedure

Do Your Homework!
Not all slings are the same.
Not all doctors have the same degree of experience

Your best chance to successfully treat STRESS URINARY INCONTINENCE with a sling is with your FIRST procedure.

Summary:

The SUBURETHRAL SLING is a vaginal procedure used to correct (stress urinary incontinence) loss of urine during physical activity – running, jumping, coughing, sneezing, lifting etc..

Through a small vaginal incision a (sling) permanent mesh-like material (Prolene) is placed underneath the mid portion of the urethra. The mesh-like material remains as a permanent sling under the urethra. The Sling causes the urethra to close when the patient puts pressure on the bladder (strains, laughs, coughs, etc.). As a result, episodes of stress incontinence are prevented or improved.


Benefits include:

  • Minimally invasive outpatient procedure (approx 30 to 40 minute procedure) performed through Small vaginal incision.
  • high success rate in treating stress incontinence
  • 50% chance of improving symptoms of overactive bladder (OAB) – sudden urge to urinate, frequent trips to the bathroom to urinate.
  • Return to work quickly (1 week) -No heavy lifting, straining or sex for 4 to 6 weeks
  • TRANS-OBTURATOR SLING – brand names include the TVT-O (Gynecare), Monarch (American Medical Systems), OBTRYX (Boston Scientific), URETEX TO (CR Bard) etc.
  • MINI –SLINGS - brand names include the TVT- Secur (Gynecare), The Mini-Arch (American Medical Systems) etc.

NOT all slings are the same- if you are going to have a “TVT” find out specifically what your doctor means by this- is it: RETROPUBIC, TRANS-OBTURATOR, MINI-SLING and is it a permanent synthetic material or a biologic material.

Do Your Homework!
Not all slings are the same.
Not all doctors have the same degree of experience

Your best chance to successfully treat STRESS URINARY INCONTINENCE with a sling is with your FIRST procedure.

 

Clinical Data:

Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence.

Int Urogynecol J Pelvic Floor Dysfunct. 2008 Aug;19(8):1043-7. Epub 2008 Jun 6.
Nilsson CG, Palva K, Rezapour M, Falconer C.

The aim of this study was to evaluate the long-term effectiveness and safety of the tension-free vaginal tape (TVT) procedure. In a Nordic three-center prospective observational cohort study, 90 women with primary stress incontinence had a TVT operation performed in local anesthesia. Assessment included a 24-h pad test, a stress test, physical examination, and a visual analog scale for assessing the degree of bother. Patient's global impression of cure was obtained, and condition specific quality of life questionnaires were used. Seventy-seven percent of the initial cohort of 90 women and 89% of those alive and capable of cooperating were assessed 11.5 years after the TVT operation. Ninety percent of the women had both a negative stress test and a negative pad test being objectively cured. Subjective cure by patients global impression was found in 77%, 20% being improved and only 3% regarded the operation as a failure. No late-onset adverse effects of the operation were found, and no case of tape erosion was seen. The TVT procedure is safe and effective for more than 10 years.

"A three-year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence",

Ulmsten et al, Br J Obstet Gynecol 1999 April:106(4) pp345-350.)

three year study: 86% of women were cured with another 11% significantly improved.

Surgical Intervention for Stress Urinary Incontinence: Comparison of Midurethral Sling Procedures

Joseph M. Novi, DO; Beth H.K. Mulvihill, DO
JAOA • Vol 108 • No 11 • November 2008 • 634-638

Context: The synthetic, tension-free midurethral sling was introduced in the 1990s as a surgical treatment for women with stress urinary incontinence (SUI). Several similar products are now available. The authors generated data comparing clinical outcomes of two midurethral sling procedures.

Objective: To compare clinical outcomes of two midurethral sling procedures currently used for the treatment of women with SUI: Gynecare Tension-free Vaginal Tape (TVT; Ethicon Women's Health & Urology, Somerville, NJ) and Uretex Self-Anchoring Urethral Support System (CR Bard Inc, Covington, Ga).

Methods: A nonrandomized, prospective study was conducted at a urogynecology practice with women who had preoperative urodynamically proven SUI. The study consisted of two phases: 100 consecutive cases using the TVT midurethral sling, then 100 consecutive cases using the Uretex midurethral sling. Symptom improvement was evaluated at 12-month postoperative follow-up by measuring rates of prolonged intermittent self-catheterization, urinary tract infection, urinary retention requiring urethrolysis, and new-onset urge incontinence.

Results: The TVT and Uretex groups were similar with respect to age, parity, and incidence of prior anti-incontinence surgery. There was no significant difference in outcomes measured between the two groups in symptom improvement at 12-month follow-up.

Conclusion: The TVT and Uretex midurethral slings demonstrate similar short-term improvement and complication rates in a nonrandomized population of women with SUI.

Prevalence of Persistent and De Novo Overactive Bladder Symptoms After the Tension-Free Vaginal Tape

Obstetrics & Gynecology:
December 2004 - Volume 104 - Issue 6 - pp 1263-1269
Segal, Jeffrey L. MD et al,

OBJECTIVE: The purpose of this study was to assess 1) the proportion of de novo urge incontinence and overactive bladder symptoms after a tension-free vaginal tape (TVT), and 2) the natural history of preoperative urge incontinence and overactive bladder symptoms after a TVT.

RESULTS: Ninety-eight patients were included in the study. Postoperatively, de novo urge incontinence symptoms developed in 9.1%, de novo overactive bladder symptoms developed in 4.3%, and 8.7% started taking anticholinergics for the first time. After a TVT, the urge component resolved in 63.1% of those with preoperative symptoms of mixed incontinence, overactive bladder symptoms resolved in 57.3% of those with preoperative overactive bladder symptoms, and 57.7% of those who used anticholinergics preoperatively no longer needed to do so. There was also a statistically significant improvement in comparing the preoperative and postoperative IIQ-7 and UDI-6 scores.

CONCLUSION: The proportion of patients in whom de novo overactive bladder or urge incontinence symptoms developed postoperatively is low, and approximately 57% of patients with preoperative overactive bladder symptoms can expect resolution of these symptoms after a TVT.

Do Your Homework!
Not all slings are the same.
Not all doctors have the same degree of experience

Your best chance to successfully treat STRESS URINARY INCONTINENCE with a sling is with your FIRST procedure.

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