[Repair of female urinary incontinence with prolene "TVT": preliminary results of a multicenter and prospective survey].
OBJECTIVE
A multicentre, prospective study (6 private centres, 1 general hospital and 1 teaching hospital) was conducted to evaluate the perioperative morbidity and short-term functional results of the TVT procedure in the treatment of the female urinary stress incontinence.


METHODS
From November 1996 to September 1999, 120 patients with a mean age of 65.2 years (range: 37-91) were operated according to the tension-free vaginal tape (TVT) technique for isolated urinary stress incontinence (stage 2 or 3) in 94 cases and associated with pelvic tone disorder in 26 cases. 59 patients (49.2%) presented recurrence of urinary incontinence that had already been operated between 1 and 4 times. Physical examination demonstrated hypermobility of the urethra in 73 cases (60.8%), isolated clinical sphincter incompetence in 47 cases (39.2%) and pelvic tone disorders in 31 cases. Urodynamic studies, performed in 113 patients, demonstrated sphincter incompetence in 65 cases (57.5%) with a mean maximum urethral closure pressure of 18 cmH2O (range: 5-29).


RESULTS
The operation, performed under spinal anaesthesia in 97 cases (80.8%), general anaesthesia in 16 cases (13.3%) and local anaesthesia in 7 cases (5.8%) lasted an average of 28.7 min (range: 15-60) for insertion of the TVT. Perioperative complications consisted of twelve bladder injuries (10%) and two pelvic haematomas (1.7%). No cases of infection, erosion or migration of the tape were reported. In the group of 94 patients operated exclusively by TVT, the mean hospital stay was 2.6 days (range: 1-7). Twelve patients (10%) required self-catheterization for 2 to 30 days. With a mean follow-up of 15.2 months (range: 36-6), continence was restored in 104 patients, corresponding to a cure rate of 86.7%. A marked improvement was obtained in 11 cases (9.2%) and five cases (4.2%) were considered to be failures.


CONCLUSIONS
The TVT procedure is a new approach to the treatment of female urinary stress incontinence. Its advantages are its simplicity, the rapidity of the technical procedure and the short-term efficacy on continence. A longer follow-up is essential to assess to the functional outcome and the long-term urethral tolerance.
Soulié
M
M
Service de Chirurgie Urologique et d'Andrologie, CHU de Rangueil, Toulouse, France. soulié.m@chu-toulouse.fr
Delbert-Julhes
F
F
Cuvillier
X
X
Mouly
P
P
Thanwerdas
J
J
Dufeuil
P
P
Larroque
J M
JM
Bernstein
J
J
Soulié
R
R
Chemasle
C
C
Brucher
P
P
Vazzoler
N
N
Seguin
P
P
Pontonnier
F
F
Plante
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D011446:Prospective Studies; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods
D011126:Polypropylenes