SUMMARY
Female unnary incontinence IS a distressing condition causmg significant morbidity, affecting die socia'l, psychological, occupational, physical and sexual lives of 15% to 70% of the female population depending on which age groups are analyzed.
The mode of urinary leakage most commonly cliagnosec is that of genuine stress incontinence. The international continence society defines genuine stress incontinence as involuntary loss of urine during maneuvers that increase intra-abdominal pressure (for example coughing), and reflects urethral hypermobility or intrinsic sphincter deficiency in absence of detrusor activity.
Althollgh conservative treatment alternatives for stress incontinence might give temporary relief, definite cure of the illness requires surgery. Successful incontinence surgery has traditionally been rather invasive, involving general anesthesia and laparotomy.
Burch colposuspension IS a well established operatiOl) for the correction of anatomic stress incontinence. But even in the hands of experienced incontinence surgeons, this operation and other various sl ing procedures resul~s in Cllre rates tens of percents below one hundred. Moreover such major surgery is associated with post-operative morbidity, tendency for urinary retention, the need for catheterization, prolonged sick-leave and considerable costs.
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introduction of the endoscopic techniques has profoundly altered the postoperative recovery and enabled early release from the hospital. However, it still requires general anesthesia, long operative
• time, skillful surgeons, expensive equipment and overnight stay at the hospital. The same urinary retention problems as after Burch performed by laparoscopy are present and restriction from physical exercise for several weeks is also a defect.
Today there is an increased request for less invasive and simpler methods for surgical treatment of stress incontinence. Despite the fact that some procedures fulfil the criteria of minimal invasiveness, the cure rates and the duration of effectiveness have, however, not reached acceptable levels. This is true for periurethral injections and for most needle suspension procedures.
While the traditional surgical methods for curing incontinence rely on the 'pressure transmission theroy', a new 'integral theory has been presented by Petros and Ulmsten in (1993) according to which incontinence is caused by impaired collagen function causing disruption of elements necessary to maintain anatomical structures invofved in the closure mechanism of the urethra. These elements are th.~ pubourethral ligaments, the vaginal insertion of the pubococcygeal;muscles and the vaginal sUPP9rt of the urethra. Based on this theory a new sugical procedure has been presented by Ulmsten and Co-Workers in (1996) called the tension-free vaginal tape procedure. In the previous study very promising results on the effectiveness of the tension-free vaginal tape procedure in curing stress incontinence have been presented.
The tension-free vaginal tape procedure fulfills the criteria of minimal invasive incontinence surgery which are short hospital stay (less than 24 hours), post operative mobilization within hours, no need for indwelling catheters or .drains, . normal everyday physical activity, physical exercise possible 2 weeks postoperatively, the use of local anesthesia, minimal tissue destruction, short duration of the operative technique, less need for postoperative analgesia and hence the short term and long term complication should be less. At the same time the results of such procedure are very promising with a cure rate of more than 85%.
The aim of our study was to evaluate the safety and efficacy of the TVT procedure for the surgical treatment of female genuine stress urinary incontinence and to test its applicability as an ambulatory and minimal invasive operation.
Between July 2000 and November 200 I, in obstetrics and Gynecology Department, Benha Faculty of Medicine, 30 women suffering from genuine stress urinary incontinence underwent the TVT procedure were included in this study.
All patients were assessed clinically and by llfodynamic studies pre-operatively and two months post-operatively. Also, ~ll patients were assessed clinically 6 & 12 months post-operativeJy. If results of the llfodynamic studies were not satisfactory at th.e second month postoperative"ly, they were repeated at the 6 or 12 months.
Our results showed that tension-free vaginal tape procedure is a highly effective procedure in treating female genuine stress urinary incontinence type I and II but its role in treating GSI type III should revised on a greater number of cases. In our study, the overall success
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rate was 93.3% (90% cure & 3.3% significant improvement) and the results did not change after 12 months follow-up .
Moreover, it was documented in the present study the criteria of
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minimal invasiveness of the tension-free vaginal tape procedure as the short hospital stay, immediate post-operative ambulation, no need for indwelling catheters, the use of local anaesthesia, minimal tissue destruction, short duration of the operative technique, less need for postoperative analgesia and the less incidence of complications.
We could conclude from our study that tension-free vaginal tape procedure (TVT) appears to be a safe and effective minimally invasive ambulatory surgical technique for treatment of female genuine stress incontinence type I and II. Its role in treating GSI type III should be revised on a greater number of cases.
We could conclude also that the TVT is at least as effective in obese women as in those with a lower RML
We recommend further studies to be done on larger number of patients and for follow-up for longer periods to test the' effectiveness of this procedure on the long run. Also we .,.. that
recommend all gynecologists should learn the technique and apply it for the properly selected cases. -141 |
