Ultrasonographic and urodynamic evaluation after tension free vagina tape procedure (TVT)

Background. This study was carried out to evaluate the urodynamic and ultra sonographic findings after tension-free vagina tape (TVT) procedure on stre ss urinary incontinent women. Methods. Ninety women sufft ling From genuine stress incontinence without p elvic relaxation syndrome underwent surgery. Urodynamic measurement, one-ho ur pad test and introital ultrasonographic evaluation were performed preope ratively and one year after surgery Additional ultrasonographic surveillanc e of the urethra was performed immediately after the operation. The positio n and mobility of the bladder neck was compared pre- and post-operatively i n relation to the inferior edge of the pubic symphysis. Result. Eight women were excluded for various reasons. Among the 82 women w ho completed the study 76 (93%) were cured, four were improved and two fail ed. No major intra- or postoperative complications occurred. The position a nd mobility of the bladder neck showed no significant difference before and after surgery. A urethral knee angle was noted ultrasonographically on cur ed and improved patients during maximum straining. Nine patients with immed iate postoperative voiding difficulty were found to have a pronounced mid-u rethra angulation. The symptom and sign were resolved by time after urethra depressing. Urodynamic assessment of the urethral pressure profile and oth er parameter showed no significant difference before and after the surgery except that a positive pressure transmission in the middle portion of the u rethra was noted among 70 (87.5%) of cured and improved subjects. Conclusion. Tension-free vagina tape operation is an effective surgical pro cedure for the treatment of female urinary stress incontinence. The procedu re seems neither to change hypermobility nor to elevate the position of bla dder neck. Urinary continence after surgery is most probably achieved by cr eating a dynamic mid-urethral knee angulation by which the urethra is close d i.e. kinked at stress. Lifting of the mid-urethra resulted in postoperati ve voiding difficulty. It is the important that the tape is placed tension free under the urethra. Introital ultrasonographic surveillance is a suitab le technique to visualize the result of the operation.