title: Correlation of morphological alterations and functional impairment of the tension-free vaginal tape obturator procedure.
abstract: OBJECTIVE
  We explored the morphological features associated with functional impairment in patients undergoing the tension-free vaginal tape obturator procedure.
  
  
  METHODS
  We retrospectively reviewed the records of 98 women who underwent the tension-free vaginal tape obturator procedure alone or with concomitant pelvic surgery. Postoperative assessment included a symptom questionnaire, ultrasound cystourethrography and a cough stress test. During followup the measures of postoperative functional impairment included a positive cough stress test, new onset voiding dysfunction and the worsening or progression of urge symptoms.
  
  
  RESULTS
  Median followup was 22 months. During followup 11 women had a positive cough stress test, 22 had voiding dysfunction and 12 had worsening or new onset urge symptoms. Failure was associated with 4 variables on multiple logistic regression analysis, including absent urethral encroachment at rest (OR 16.63, 95% CI 1.87-147.85, p = 0.01), bladder neck funneling (OR 8.27, 95% CI 1.99-34.26, p <0.01), a urethral location of less than the 50th percentile (OR 6.01, 95% CI 1.43-25.25, p = 0.01) and a resting tape angle of less than 165 degrees (OR 5.21, 95% CI 1.15-23.54, p = 0.03). A resting tape distance of less than 12.0 mm (OR 3.00, 95% CI 1.44-6.26, p <0.01) and urethral encroachment at rest (OR 2.86, 95% CI 1.30-6.30, p <0.01) were the variables predictive of postoperative voiding dysfunction. Bladder neck funneling was the only risk factor for postoperative urge symptoms (p <0.01).
  
  
  CONCLUSIONS
  The tension-free vaginal tape obturator procedure achieves its effectiveness in a process of biological reaction and mechanical interaction between the tape and urethra. When this mechanical interaction is too great or too little, there is functional impairment after the procedure.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
authors.forename: Jenn-Ming
authors.initials: JM
authors.lastname: Yang
authors.forename: Shwu-Huey
authors.initials: SH
authors.lastname: Yang
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011475:Prosthesis Failure; D012189:Retrospective Studies; D053825:Suburethral Slings; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000503:physiopathology* / Q000601:surgery*