Ultrasound assessment of mid-urethra tape at three-year follow-up after tension-free vaginal tape procedure.
OBJECTIVE
To evaluate the anatomic changes in the polypropylene mesh sling after a tension-free vaginal tape (TVT) procedure using introital ultrasonography in a prospective study.


METHODS
Eighty women with genuine stress incontinence but without pelvic relaxation syndrome underwent surgery. Introital ultrasound evaluation of the mid-urethra TVTs was performed after surgery.


RESULTS
Of the 70 women available for evaluation at postoperative year 3, 62 (88.5%) were objectively cured and 6 had improvement; in 2 patients, the procedure had failed. The measurement of the tape position from the bladder neck at the first and third year compared with the tape position at 1 month revealed no statistically significant differences. The tapes were located at the mid-urethra in 60 patients (85.7%) and at the proximal urethra in 10. The measurement of the tape from the lower margin of the symphysis pubis using the rectangular coordinate system showed the tape had a downward descent of 1.7 mm at 3 years of follow-up. The rate of descent decreased during the study period. The mean thickness and width of the tape increased with time. A urethral knee angulation during maximal straining was found in 60 patients (92%), with the tape positioned at the mid-urethra for the follow-up period.


CONCLUSIONS
The observations of the tape position and characteristics suggest that shrinkage and compromise of the TVT sling does not occur. The TVT sling fixes to its original implanted site along the urethra and appears to slowly descend with the surrounding tissue with time. The urethra dynamic kinking contributes to the postoperative urinary continence when the TVT sling is placed at the mid-urethra.
Lo
Tsia-Shu
TS
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan Hsein, Taiwan, Republic of China.
Horng
Shang-Gwo
SG
Liang
Ching-Chung
CC
Lee
Shu-Jane
SJ
Soong
Yung-Kuei
YK
D000328:Adult; D000368:Aged; D003127:Colposcopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011126:Polypropylenes; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D013526:Surgical Mesh / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D014521:Urethra / Q000000981:diagnostic imaging / Q000601:surgery*; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000601:surgery; D014546:Urinary Catheterization; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000601:surgery*; D014563:Urodynamics / Q000502:physiology; D014621:Vagina / Q000601:surgery
D011126:Polypropylenes