[A comparative study between two procedures of TVT retropubic mid-urethral sling placement for treatment of female stress urinary incontinence]. / Étude comparative entre deux procédures de mise en place d'une bandelette sous-urétrale rétropubienne TVT dans le traitement de l'incontinence urinaire d'effort féminine.

OBJECTIVE: To evaluate complications and functional outcomes at 1 year and more of a modified Tension-free Vaginal Tape (TVT) technique from that of classic TVT. PATIENTS AND METHODS: Retrospective study comparing the two techniques. For the modified TVT technique, a peri-urethrovesical hydrodissection was performed. An 18-gauge hollow needle, in which a thread was introduced, was used as an ancillary for the placement of the sling. The sling was secured to the thread and then positioned with it. Bladder filling objectified perforations. An absorbable suture around the sling allowed its descent if necessary. RESULTS: One hundred and eighteen procedures were performed (54 classic TVT and 64 modified TVT). For the standard TVT and the modified TVT, the vesico-urethral perforation rates were respectively 7.4% and 1.5% (P<0.05), those of reoperations for pulling the sling downward 11.1% and 1.5% (P<0.05). A 1 year and more, healing and satisfaction rates were respectively 83.3% and 79.2% for the standard TVT versus 88.2% and 90% for the modified TVT (NS). The dissatisfaction rate was lower for the modified TVT (P<0.05). CONCLUSION: By modifying the placement of the classic TVT, it is possible to reduce its complications while maintaining its efficacy.

[Suburethral sling procedures for stress urinary incontinence]. / Bandelettes sous-urétrales et incontinence urinaire d'effort.

The rational of the surgical treatment of female stress urinary incontinence has changed over the past few years. The techniques of colposuspension have been replaced by the suburethral slings, retropubic initially with the TVT, recreating a backboard between the urethra and the vaginal anterior wall. Nevertheless with overall cure rates of 69% to 88%, in periods beyond 5 years, the colposuspension still remains the reference (high-grade scientific evidence). Based on observational studies (low quality scientific evidence), with generally a short follow-up, the results of the TVT appear similar. More recently, the suburethral transobturator tape (TOT) was introduced to reduce the complications of the TVT. It is thus difficult to currently have an objective idea of the effectiveness of the TOT compared to the TVT, even if the first impressions, with respect to the TOT, are rather favourable. Furthermore the TOT technique itself and the biomaterials used, have continued to evolve. In fact, if the complications of these two kinds of suburethral slings are different: bladder perforation for the TVT, prosthetic erosion for the TOT, in contrast, in the future, their indications could be different. Therefore the TVT appears more effective in presence of intrinsic sphincter deficiency with urethral hypermobility.