title: Ultrasound and urodynamic comparison between caudocranial and craniocaudal tension-free vaginal tape for stress urinary incontinence.
abstract: OBJECTIVE
  To compare the efficacy and safety of the conventional caudocranial tension-free vaginal tape (TVT) procedure and craniocaudal TVT procedure for the treatment of primary stress urinary incontinence.
  
  
  METHODS
  Ninety patients with urodynamic stress incontinence and without prolapse underwent a caudocranial TVT (45 women) or craniocaudal TVT (45 women) procedure. The two patient groups were comparable in terms of age, parity, body weight, previous pelvic surgery, and menopausal status. Both methods were performed under local anesthesia with adequate sedation. Introital ultrasound evaluation on the mid-urethra TVT tapes and urodynamic evaluation was performed before and after surgery.
  
  
  RESULTS
  The average follow-up period for caudocranial TVT and craniocaudal TVT was 1.9 years and 1.4 years, respectively. Objective evaluations were performed at similar times at 1 year postoperatively. No significant differences were found in the cure rate at 88.9% (40 of 45 women) after caudocranial TVT and 91.1% (41 of 45 women) after craniocaudal TVT (P = 1.000). The intraoperative complications were minor. No patient had long-term voiding difficulty or required long-term catheterization. Both groups had the vaginal tape implanted at the mid-urethra, with a urethral knee angle observed during maximal straining. A more proximal tape position, less elasticity of the tape, and more obstruction by the sling were found using the craniocaudal approach. Postoperative dysfunctional voiding was minor.
  
  
  CONCLUSIONS
  The caudocranial and craniocaudal TVT procedures are highly effective, minimally invasive, and safe procedures in the treatment of urinary stress incontinence. The variations in implanted tape position and postoperative sling obstruction were most likely caused by the mode of insertion.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan, Republic of China. 2378@cgmh.org.tw
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Shang-Gwo
authors.initials: SG
authors.lastname: Horng
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
authors.forename: Shu-Jane
authors.initials: SJ
authors.lastname: Lee
authors.forename: Huei-Jean
authors.initials: HJ
authors.lastname: Huang
authors.forename: Cheng-Tao
authors.initials: CT
authors.lastname: Lin
mesh_terms: D005260:Female; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics