Results with the Tension-Free Vaginal Tape (TVT) technique and other pelvic floor surgical procedures in the treatment of stress urinary incontinence

Abstract

BACKGROUND: Stress urinary incontinence is defined as the involuntary loss of urine after exertion, coughing, or during exercise. It is currently estimated that urinary incontinence affects 40% of adult women, 50% of whom experience stress incontinence. Around the year 2000, the physiological anatomical support of the pelvis began to be replaced with the implementation of mid-urethral slings. However, since then and to date, the appropriate tension has not been standardized during the surgical procedure, which has led to major complications. MATERIALS AND METHODS: Retrospective, observational case series study and literature review, which included 100 adult women with stress incontinence, treated with TVT surgery, reconstructive vaginal hysterectomy, anterior and/or posterior colpoperineoplasty alone, or colposacropexy. Search of electronic databases with MeSH terms: “urinary incontinence,” “female stress urinary incontinence,” and “tension-free vaginal tape.” The search was limited to the following filters: “Case Reports,” “Review,” and “Systematic Reviews,” “Spanish and English” from 1961 to 2018. A total of 261 studies were found, from which editorials, reviews, and duplicate articles were excluded. Twelve studies were selected. RESULTS: Patients with a mean age of 64 years, 36 underwent TVT + HVR, 25 underwent TVT + sacrospinous fixation, 20 underwent TVT only, and 19 underwent TVT + anterior colpoperineoplasty. After 12 months of follow-up, 76 patients had a favorable and satisfactory response to the different treatments. Regarding unfavorable results, 8 patients continued to experience urinary urgency, 8 had urinary incontinence, 3 developed urinary retention, and the remaining 5 patients shared data such as recurrent UTIs, mild dysuria, and dyspareunia. CONCLUSIONS: The use of different surgical techniques together with TVT continues to be the best option for patients diagnosed with stress urinary incontinence. however, the appropriate tension is not standardized during the surgical procedure, which is the source of the main complications reported by this and other studies, such as persistent urinary incontinence and urinary retention, as well as data on a low irritative syndrome. Therefore, it is essential to continue studying these types of cases in the future until a standard procedure is established that offers the fewest adverse results.