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| |  Adjustable Tape for the Treatment of Female Stress Urinary Incontinence: Presented at CURy By Chris Berrie BARCELONA, SPAIN -- February 5, 2008 -- Postoperative readjustments in tension that have been applied to a transvaginal adjustable (TVA) tape during surgery allows correction of persisting stress incontinence and avoidance of obstruction in women with stress urinary incontinence (SUI). There is a delicate balance between incontinence, continence, and obstruction that can cause difficulties after surgery with placement of the standard transvaginal tape, said Manuel Ortiz Gorraiz, MD, Resident Urologist, Urology Department, San Juan de Alicante Hospital, Alicante, Spain, speaking here at the first World Congress on Controversies in Urology (CURy). In a presentation on February 2, Dr. Gorraiz described for the first time the use of a macroporous, polypropylene, monofilamentous TVA tape that has two groups of polypropylene threads to allow postoperative adjustments of tension. These threads can be removed when continence without obstruction is reached. His team enrolled 64 women with incontinence; 53% had stress incontinence and 47% had mixed incontinence. After surgery, these women were monitored after 1, 6, and 12 months, and then every year thereafter. Objective cure for stress incontinence was defined as no leakage on the cough-provocation test, with subjective cure defined as an answer of "never" to the International Consultation on Incontinence (ICIQ) question, "How often do you leak urine?" In the immediate postoperative evaluation, 75% of women were continent. With the 10 continent patients (16% of total patents) who had obstruction (maximal flow rate [Qmax] <10 mL/s and/or >50 mL residue), the TVA tape was adjusted to render them continent; none of these patients had postvoid residual urine volume and they reached a Qmax of 15 mL/s. No vesical catheterisation was needed in any patient. With a mean follow-up of 40 months, the objective cure rate was 94%, with a further 3% who were greatly improved. The subjective cure rate was 56% who never leaked urine. Failures in the subjective cure category arose from urgency incontinence (27% of total patients), stress incontinence (11%), and mixed incontinence (6%). With a Qmax of 22.3 mL/s, the incontinence quality-of-life questionnaire showed an improvement from 31.6 to 85.7 points, while the patient global impression of improvement showed 94% of the total patient population to be better or very much better than before surgery. There were no cases of bowel, nerve, or major vessel injury, and there was no infection or vaginal or urethral erosions. This study demonstrates the benefits of this TVA tape over the use of traditional nonadjustable mesh, while also showing no increased surgical complications. "We think it will be a good solution for a lot of women at this moment," added Dr Gorraiz.
[Presentation title: Adjustable Tape for the Treatment of Female Stress Urinary Incontinence. Poster 38]
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