title: Funneling before and after anti-incontinence surgery--a prognostic indicator? Part 2: tension-free vaginal tape.
abstract: Does the presence of pre- and postoperative funneling of the proximal urethra affect the outcome of tension-free vaginal tape (TVT)? This prospective study of 191 women with proven primary genuine stress urinary incontinence treated by TVT insertion and assessed by pre- and postoperative introital ultrasound aims to answer that question. At 36-month follow-up, the cure rate was 89.5% (Kaplan-Meier estimator). At 6-month follow-up, 6.3% of the women had urge symptoms and 0.5% de novo urge incontinence. The cure rate in preoperative funneling was 77.5% as opposed to 96.6% in the group without funneling (P<0.0001). The funneling rate significantly decreased from 37.2% preoperatively to 17.3% immediately postoperatively (P<0.0001). The continence rate was 57.5% in persistent postoperative funneling vs 96.2% in the group without postoperative funneling (P<0.0001). The complication rate was not higher in the group with persistent postoperative funneling. The TVT procedure significantly reduces bladder neck funneling. Both preoperative and persistent postoperative funneling are associated with an increased probability of therapeutic failure or recurrence.
authors.affiliation: Department of Gynecology and Obstetrics, Georg August University Goettingen, Goettingen, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Harms
authors.forename: Günter
authors.initials: G
authors.lastname: Emons
authors.forename: Werner
authors.initials: W
authors.lastname: Bader
authors.forename: Rainer
authors.initials: R
authors.lastname: Lange
authors.forename: Reinhard
authors.initials: R
authors.lastname: Hilgers
authors.forename: Volker
authors.initials: V
authors.lastname: Viereck
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D019736:Prostheses and Implants; D014549:Urinary Incontinence / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*