title: [TVA and TOA. New adjustable mesh for the treatment of female stress incontinence. Preliminaries results].
abstract: OBJECTIVE
  Evaluation of a new mesh for incontinence (TVA/TOA) which enables the degree of tension applied during surgery to be readjusted at the post-operative stage.
  
  
  METHODS
  62 patients treated with the TVA mesh and monitored over a 14-month period (SD 7.8, range 6-38). In 33 patients (53%) some other pelvic prolapse was corrected. Evaluation was carried out by clinical report, examination of bladder full of 250 saline solution, flowmetry and urinary residue. 40 patients filled in 4 quality of life questionnaires (QoL; ICIQ-SF; PGI-S; PGI-I).
  
  
  RESULTS
  42 patients were found to be objectively continent in the post-operative evaluation. Of these, it was necessary to reduce tension in 7 cases (11%) due to urinary obstruction (flow < 10 ml/sec and/or residue). The tension of the mesh was tightened in 20 patients (32%) due to continue with a certain degree of incontinence. All patients were discharged as continent and with no residue. In the last revision, 58 patients (93%) proved to be objectively continent and 4 (6.5%) showed a notable improvement in their incontinence. The Q(MAX) is 19.8 ml/sec (SD 9.8). The mictional urgency had disappeared or improved in 32 of the patients who had this prior to operation (76%) and had appeared in 3 of the patients who didn't (15%). The clinical report showed a high level of consensus with the ICIQ-SF survey (Kappa = 0.89) regarding stress incontinence, diminishing clearly (Kappa= 0.13) when urge incontinence was taken into account. 34 (85%) patients scored over 95 out of 110 in the QoL. 30 (75%) scored less than 6 in ICIQ-SF. 32 (80%) showed a perception of normality and 4 (10%) slight illness in the PGI-S. In the PGI-I 29 (72.5%) were much better and 11 (27.5%) quite a lot better. A relation exists between urgency and dismissed quality of life.
  
  
  CONCLUSIONS
  With the TVA (trans-vaginal adjustable) mesh it is possible to adjust the tension originally applied during surgery at the post-operative stage, so that any defects or excesses can be corrected.
authors.affiliation: Servicio de Urología, Hospital Universitario San Juan de Alicante. romero_jes@gva.es
authors.forename: J
authors.initials: J
authors.lastname: Romero Maroto
authors.forename: M
authors.initials: M
authors.lastname: Ortiz Gorraiz
authors.forename: L
authors.initials: L
authors.lastname: Prieto Chaparro
authors.forename: C
authors.initials: C
authors.lastname: López López
authors.forename: J M
authors.initials: JM
authors.lastname: Quílez Fenoll
authors.forename: E
authors.initials: E
authors.lastname: Rodríguez Fernández
authors.forename: J J
authors.initials: JJ
authors.lastname: Pacheco Bru
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D013526:Surgical Mesh; D014550:Urinary Incontinence, Stress / Q000601:surgery*