Efficacy of tension free vaginal tape [TVT] and burch colposuspension in patients with genuine stress urinary incontinence

ABSTRACT

Aim of the work is to compare the new urethropexy technique, the T.V.T and the gold standard Burch colposuspension, both clinically and urodynamically in patients with genuine urinary stress incontinence. Prospective randomized study. The study was held in Ain Shams University Maternity Hospital between June, 2002, and March, 2003. A randomized study involving 20 patients of combarable age and parity. Randomization were done using a table of random numbers then each patient were given a serial number and received the corresponding therapy. They were divided into two groups. The first group underwent T.V.T for treatment of genuine S.U.I. The second group underwent Burch colposuspention for treatment of genuine S.U.I. The tension free vaginal tape fulfill the criteria of minimal invasive incontinence surgery which are short hospital stay, early postoperative mobilization, no need for urinary catheter or drains, normal everyday physical activity, the use of regional anaethesia, minimal tissue destruction, short duration of operative technique and less need for postoperative analgesia. Results showed that TVT procedure is highly effective in treating female genuine stress incontinence. The results TVT was comparable to the results of the gold standard Burch colposuspension. The study also showed the effect of TVT on the bladder neck mobility and rotational angle which differs from the effect of colposuspension. In the T.V.T. group, the subjective success rate was 90% three month postoperatively. In the Burch group, the subjective success rate was 90% three month postoperatively. In the T.V.T. group, the objective success rate was [90%] three month postoperatively. In the Burch group, the objective success rate was [90%] three month postoperatively. Duration of the operation descriptive statistics and analytical difference between the two studied groups [in minutes] showed that there is very highly significant difference between the two groups, as regards operative time in favour of TVT group. As regard postoperative hospital stay descriptive statistics and analytical difference between the two studied groups [in days], There was very highly significant difference between the two groups, as regards the postoperative hospital stay, in favour of TVT group. From the present study, it is concluded that the tension free vaginal tape is a safe and effective minimally invasive surgical procedure for the treatment of female genuine stress incontinence. The TVT procedure appears to be technically feasible and effective as a treatment for stress urinary incontinence when combined with other pelvic floor reconstructive surgery. Care must be taken to make sure that the sling does not migrate to the bladder neck and that it is not at all obstructive