Modified TVT sling reduces pain, complications after surgery for SUI
The use of the tension-free vaginal tape (TVT)-Abbrevo sling, a modification of the TVT-obturator (TVT-O) with a shorter mesh (12 cm), was associated with a reduced groin pain and minimal complications following surgery for stress urinary incontinence (SUI) in women, according to a Singapore study.
“The shorter mesh length and less dissection in TVT-Abbrevo reduces complications and pain … [enabling] faster recovery while giving the same tension-free support to the midurethra,” said the researchers.
Seventy-six women with SUI who had TVT-Abbrevo at the KK Women’s and Children’s Hospital in Singapore were evaluated for a period of 22 months. Groin or thigh pain was assessed during the postoperative period (day 0 [within 6 hours, n=76], day 1 [n=71], and days 3–10 [n=67]) and follow-up visits (one month [n=70], 6 months [n=66], 1 year [n=53], and 2 years [n=9]).
Fifty-one participants had demonstrable SUI on erect or supine stress test, while 42 had concomitant urgency and urge incontinence. Preoperative urodynamic study (UDS) revealed leakage and concomitant detrusor overactivity (DO) in 49 and 26 participants, respectively. [Singapore Med J 2017;58:338-342]
Of note was the absence of pain among participants at 6 months and 2 years compared with reports of pain in 43 participants at day 0. This supports previous findings of reduced groin pain with TVT-Abbrevo vs TVT-O, which is associated with groin pain persisting beyond the immediate postoperative period. [Surg Technol Int 2012;22:149-157]
Compared with the preoperative UDS, 6-month postoperative results showed a significant reduction in terms of maximum flow rate (17.7 mL/s vs 21.6 mL/s), mean leak amount (2.5 g vs 44.7 g), and DO (22.7 percent vs 34.2 percent).
Complications were minimal, with only three cases of asymptomatic tape erosion and one case of recurrent urinary tract infection at 6 months.
Given the minimal complications associated with TVT, the procedure has become the gold standard for SUI management. “Modifying the tape and technique (such as in TVT-Abbrevo) to further reduce complications without compromising on the results is a promising option,” said the researchers, adding that TVT-Abbrevo has been the treatment of choice since its approval by the US Food and Drug Administration in 2010.
In addition to the safety, efficiency, and reduced groin pain associated with TVT-Abbrevo, using this is also easier and less invasive than using TVT-O, noted the researchers. “[This] provides an obvious advantage for both the patient and the surgeon.”
While the long-term results of this trial have yet to be released, the researchers noted that the 22-month prospective analysis is already ‘encouraging’.