Modest long term success is one of the most disappointing issue facing patients undergoing anti-incontinence surgery. Urinary retention or persistent of incontinence in the post operative period is also an unavoidable situation . Herein we introduce a novel surgical modification with double tension adjustment on tension- free vaginal tape(TVT).
Material and methods: Thirteen female patients with mean age of 48.98 years ( range 31-72) who underwent anti-incontinence surgery to correct their SUI where included. Sex of them were operated between the period of June 2010 ad Augustus 20110 and 7 patients were operated between April 2013 and April 2014 in different centers by the same surgeon. All cases were primary except two of them had previous anti incontinence surgery. Urodynamic study were done and pure SUI were diagnosed and confirmed with physical examination. In-situ anterior vaginal wall sling was prepared, and monofilament polypropylene tape passed below the insitu-sling and standard TVT procedure was performed. Two fixation sutures were placed at the lateral side of the in situ sling thus mesh dislocation was avoided. Intra-operative cystoscopy was done to rule out urethral or vesical perforation. Both ends of the mesh in the suprapubic region were labeled with vicryl sutures and left outside the skin to increase the tension of the mesh in the early postoperative period incase incontinence occurred . Similarly the middle of the mesh in the vaginal region were labeled with the same sutures and left outside the vagina to decrease the tension of the mesh in early post operative period incase urinary retention occurred. Intra-operative cystoscopy was done to rule out urethral or vesical perforation. Foley catheter was removed on the second postoperative day. The mean follow up period was 4.69 months (range: 3-13 months)
Results: The surgical technique was successful in all patients. No urinary retention was observed after catheter removal except in one patient where reduction of the tension of the sutures were done . No vaginal mesh erosion was detected during the gynecological examination postoperatively. Denovo urgency were seen in two patients one of them resolved after anticholoegric therapy for three weeks and one still present . Postoperatively no significant post-voiding residue was detected.
Conclusion: This technique give feasible option to adjust the tension of the mesh in the early post operative period in case of urinary retention or persistent incontinence. Low risk of vaginal and urethral erosion, due to the presence in-situ sling over the tape are also important advantages of this technique. Long term success is expected, because dislocation of midurethral sling are less likely. Further studies with larger number of patients and longer follow-up periods are needed to confirm these findings.