Effect of tension-free vaginal tape operation on urethral closure function.
OBJECTIVE
To evaluate whether the tension-free vaginal tape operation changes urethral hypermobility, funneling, and urethral urodynamic parameters in different parts of the urethra.


METHODS
We conducted a cohort study of our first 80 unselected female patients (age 36 to 78 years, median 53) undergoing a tension-free vaginal tape procedure. Urethral pressure profile measurements were done before and 6 and 12 months after the operation. Lateral cystography was performed before and after surgery in 50 patients. Of the 80 women, 29 had previously undergone prolapse or incontinence surgery. Parameter-free techniques were used for statistical evaluation.


RESULTS
Five patients were lost to follow-up. On an intention-to-treat basis, 66% of the patients were objectively and subjectively cured, 20% were objectively dry but subjectively occasionally incontinent, and 14% had treatment failure. The maximal urethral closure pressure at rest showed no significant changes (median baseline and 6 and 12 months postoperatively, 44, 40, and 38 cm H(2)O, respectively). The pressure transmission ratio increased in the proximal urethra (median 107.5%, 122.5%, and 123.5% at baseline and 6 and 12 months postoperatively, respectively, P <0.05) and distal urethra (median 80%, 112%, 107.5% at baseline and 6 and 12 months postoperatively, respectively, P <0.01). The downward movement of the bladder neck during the Valsalva maneuver decreased (median 2.3 cm preoperatively versus 1.7 cm postoperatively, P <0.001). Urethral rotation was diminished (median 35.5 degrees versus 23 degrees , P <0.01). Funneling was seen postoperatively in only 5 of 25 preoperative cases.


CONCLUSIONS
The tension-free vaginal tape procedure stabilizes the urethra anatomically and improves funneling and pressure transmission ratios all along the urethra. The maximal urethral closure pressure at rest decreased without statistical significance.
Koelle
Dieter
D
Department of Obstetrics and Gynecology, University Hospital of Innsbruck, Medical University of Innsbruck, Innsbruck, Austria. dieter.koelle@uibk.ac.at
Windisch
Johannes
J
Doerfler
Daniela
D
Marth
Christian
C
Kropshofer
Stephan
S
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants; D014521:Urethra / Q000502:physiology*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000379:methods; D014621:Vagina