Correlation of morphological alterations and functional impairment of the tension-free vaginal tape obturator procedure

Research output: Contribution to journalComment/debate

Abstract

Purpose: We explored the morphological features associated with functional impairment in patients undergoing the tension-free vaginal tape obturator procedure. Materials and 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 follow-up was 22 months. During follow-up 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.

Original languageEnglish
Pages (from-to)112
Number of pages1
JournalInternational Braz J Urol
Volume35
Issue number1
DOIs
Publication statusPublished - Jan 1 2009
Externally publishedYes

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Suburethral Slings
Exercise Test
Cough
Urinary Bladder
Mechanical Phenomena
Biological Phenomena
Urethra
Logistic Models
Regression Analysis

ASJC Scopus subject areas

  • Urology

Cite this

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title = "Correlation of morphological alterations and functional impairment of the tension-free vaginal tape obturator procedure",
abstract = "Purpose: We explored the morphological features associated with functional impairment in patients undergoing the tension-free vaginal tape obturator procedure. Materials and 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 follow-up was 22 months. During follow-up 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.",
author = "Yang, {J. M.} and Yang, {S. H.} and Huang, {W. C.}",
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T1 - Correlation of morphological alterations and functional impairment of the tension-free vaginal tape obturator procedure

AU - Yang, J. M.

AU - Yang, S. H.

AU - Huang, W. C.

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N2 - Purpose: We explored the morphological features associated with functional impairment in patients undergoing the tension-free vaginal tape obturator procedure. Materials and 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 follow-up was 22 months. During follow-up 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.

AB - Purpose: We explored the morphological features associated with functional impairment in patients undergoing the tension-free vaginal tape obturator procedure. Materials and 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 follow-up was 22 months. During follow-up 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.

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