Objective: To evaluate the safety and efficacy of TVT- secur hammock approach, as a new anti–incontinence surgical procedure in women
Design : A prospective controlled study .
Setting: Department of Obstetrics & Gynecology, Benha University Hospital.
Patients & Methods: Between January 2008 and October 2008, 18 patients with urodynamically proven genuine stress urinary incontinence (SUI) were included in the study and all underwent TVT-secur hammock approach under local anaesthesia. Preoperatively patients were evaluated with a cough stress test and 1-hour pad weighing test which were repeated postoperatively after 3 and 6 months. TVT-S hammock approach mimic the TVT-O placement, but with no skin exits, and required neither bladder catheterization nor intraoperative cystoscopy. Patients had a mean age of 44.9 ± 10 years (range 28-65 years), a mean parity of 4.4 ± 1.5 (range 3-8) and a mean BMI of 30.6 ± 2.1(range 27.5-34.8)
Results : Mean operative time was 10 ± 1.8 minutes (range 8-15min.), mean estimated blood loss was 30 ± 8.7 m1 (range 25-60 m1) and mean hospital stay was 9.8 ± 2.1 hours (range 8-14 hours). According to our criteria of cure, 16 patients (88.8%) were cured, 1 patient (5.6%) was significantly improved and another 1 patient (5.6%) was classified as failure. All patients were able to micturate spontaneously within 24 hours after surgery with insignificant residual urine volumes. There were no intraoperative complications and no serious postoperative complications, no significant bleeding (>100ml), no bladder perforation, urethral, bowel or vascular injuries. Also no urinary retension, no postoperative wound infection, no de novo urge symptoms or incontinence, no evidence of defective healing or tape rejection. However, early postoperatively 5 patients (27.8%) had significant vaginal pain on a duration of 4-7 days , and another 3 patients (16.7%) reported de novo dysuria due to cystitis.
Conclusion: Based on our initial results, TVT-secur hammock approach appears to be simple, quick, safe and effective minimally invasive ambulatory surgical procedure for treatment of SUI in women. However, long-term follow-up is warranted and large comparative studies are needed to determine the durability of such encouraging results.
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