Tape tensioning can be fine-tuned for continence

October 15, 2008

Tensioning is a challenge in transvaginal tape procedures for stress urinary incontinence.

What would you do if you had a second chance to get the tension just right?

That's what Jésus Romero Maroto, MD, professor and head of urology at Universitas Miguel Hernandez, San Juan de Alicante, Spain, and his colleagues were able to do with a macroporous polypropylene monofilament nonelastic tape with two groups of polypropylene threads on each side (Agency of Medical Innovations, Feldkirch, Austria).

If there is leakage, the tape is too loose, and the superior threads can be pulled up on one side to increase the tension. If there is obstruction (maximum flow rate <10 mL/s and/or >50 mL of residual urine), the tension is released from the mesh by pulling down the vaginal strings approximately 0.5 cm.

In the data presented at the AUA annual meeting, the team used the procedure in 64 incontinent women, 53% with stress incontinence and 47% with mixed incontinence. Investigators monitored the patients at 1, 6, and 12 months after surgery and annually thereafter using history, cough test, flowmetry, postvoid residual urine volume, and incontinence and global improvement questionnaires.

Immediately after surgery, 48 patients (75%) were continent and 16 (25%) were incontinent. Ten of the 48 patients (16%) had postvoid obstruction. However, after the strings were adjusted, all patients were continent, none had postvoid residual urine, and none needed catheterization.

"This is in contrast with the previously published high occurrence of voiding dysfunction in the early postoperative period-in up to 60% of patients with tape release being performed in up to 8% of the cases," Dr. Maroto said.

During surgery, there were no cases of bowel, nerve, or major vessel injury, and during follow-up, no infections or vaginal or urethral erosions were identified.

At a mean of 40 months, the objective cure (defined as no leakage on cough provocation) rate was 94%, with 3% greatly improved. The subjective cure rate (ie, answering "never" to the question, How often do you leak urine?), was 56%. However, the subjective failure rates were 28% because of urge incontinence (18 patients), 6% because of mixed incontinence (four patients), and 11% because of pure stress incontinence (seven patients).

Scores on the Urinary Incontinence Quality of Life Scale improved from 32 to 86 points; the Patient Global Impression of Improvement questionnaire showed that 94% were better or markedly better than before.