UOG Journal Club: Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures
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UOG Journal Club: Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures

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This Journal Club presentation provides a summary and discussion of the following free access article published in UOG: ...

This Journal Club presentation provides a summary and discussion of the following free access article published in UOG:

Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures
J.M. Yang, S.H. Yang, W.C. Huang, C.R. Tzeng
Volume 39, Issue 4, Date: April 2012, pages 458-465

This can be accessed here:
http://onlinelibrary.wiley.com/doi/10.1002/uog.10086/abstract

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UOG Journal Club: Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Presentation Transcript

  • 1. UOG Journal Club: April 2012 Correlation of tape location and tension withsurgical outcome after transobturator suburethral tape procedures J.-M. Yang, S.-H. Yang, W.-C. Huang and C.-R. Tzeng Volume 39, Issue 4, Date: April 2012, pages 458–465 Journal Club slides prepared by Tommaso Bignardi (UOG Editor for Trainees)
  • 2. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 BackgroundTape location and tension are among the factors that might affectsurgical outcome of transobturator suburethral tape procedures(TOTs).The location and course of the suburethral tape can bestudied with translabial and/or transperineal sonography.
  • 3. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 ObjectiveTo explore, using 4D ultrasound, the importance oflocation and tension of transobturator suburethral tape(TOT) with respect to clinical outcome measures.
  • 4. MethodologyProspective observational study of 56 women who had TOT(Monarc®) for urodynamic stress incontinenceExclusion criteria:Diabetes, neurological disease or stroke, previous or concomitantpelvic reconstructive surgery, concurrent symptoms of urgency orurgency incontinence, ≥ Stage II pelvic floor prolapse, detrusoroveractivity 4D ultrasound assessments using an introital approach a) at rest, b) during maximum strain and c) with coughing
  • 5. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 Tape location measurements sTSD: sagittal tape–symphysis pubis distance (dashed double-headed arrow) sTSA: sagittal tape–symphysis pubis angle Tape percentile: percentage of proximal urethral length (PUL) by total urethral length (TUL) (double-headed arrows)B, bladder; SP, symphysis pubis;T, tape; U, urethra
  • 6. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 Tape tension measurements sTUDu, sTUDc and sTUDl: shortest distance between upper, center and lower ends, respectively, of the tape and the midline of the urethral echolucent area in the sagittal plane Urethral encroachment: indentation in the urethral outer wall by the tape with an elevation of the inner wallB, bladder; SP, symphysis pubis; and narrowing of the echolucentT, tape; U, urethra urethral core
  • 7. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 Tape tension measurements aUCEAc, circle: urethral central echolucent area at the tape center in the axial planeSP, symphysis pubis; U, urethra;T, tape
  • 8. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 Surgical outcomesPostoperative assessments: 3 months,12 months and 24monthsIncontinence severity: Sandvik Incontinence Severity Indexand Ingelman- Sundberg ScaleQuality of life: short forms of Urogenital Distress Inventory(UDI-6) and Incontinence Impact Questionnaire (IIQ-7)
  • 9. ResultsThe intra- and interobserver reliability of ultrasound measurements ofsagittal tape–symphysis pubis distance (sTSD) and sagittal tape–symphysis pubis angle (sTSA) were good to very good. ICC (95% CI)Measurement Intraobserver InterobserverResting sTSD 0.840 (0.639–0.933) 0.794 (0.551–0.913) sTSA 0.799 (0.559–0.915) 0.831 (0.622–0.930)Straining sTSD 0.795 (0.552–0.913) 0.851 (0.661–0.938) sTSA 0.747 (0.465–0.892) 0.857 (0.674–0.941)Coughing sTSD 0.769 (0.504–0.902) 0.807 (0.576–0.919) sTSA 0.852 (0.664–0.939) 0.805 (0.571–0.918)
  • 10. Results• TOT placement is associated with increased sTSA and urethralencroachment and decreased sTUDu, sTUDc, sTUDl andaUCEAc during increased intra-abdominal pressure.• Tapes in women with recurrent SUI were placed more proximally.• Women with SUI postoperatively demonstrated no urethralencroachment at rest or with increased intra-abdominal pressure.• Women with postoperative OAB symptoms had decreased restingsTSD and larger resting sTSA.• Women reporting de novo or worsening voiding difficulty hadincreased resting sTSA and urethral encroachment. SUI, stress urinary incontinence; OAB, overactive bladder
  • 11. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 Conclusions•Both tape location and tape tension are associated withsurgical outcome of TOT procedures.•Assessment of tape location and tension can be achievedusing 4D ultrasound.
  • 12. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 Discussion points• How do suburethral slings work?• Do you think we have to compress the urethra to achieve stress continence?• Why would you want to know whether a suburethral sling is too tight, just right or too loose?• What kind of symptoms would you expect if a tape was too tight/too loose? What parameters does this paper suggest we measure to define tape tightness?• Do you know of any other, simpler sonographic measures? (see ref. 1 below)• Would the findings in this paper regarding de novo overactive bladder symptoms and worsening voiding difficulty be altered by statistical correction for multiple comparisons?• Apart from ultrasound, what other investigations would you suggest? What would you do if symptoms and investigations suggest a tape thats too tight? And what would you do if its clearly too loose?• What can we do to get sling tension right every time?• Do you think ultrasound can help?
  • 13. Correlation of tape location and tension with surgical outcome after transobturator suburethral tape procedures Yang et al, UOG, 2012 Related articlesChantarasorn V, Shek K, Dietz H. Sonographic appearance of transobturator slings:implications for function and dysfunction. Int Urogynecol J, 22:493-49 (2011).Kociszewski J, Rautenberg O, Kolben S, Eberhard J, Hilgers R, Viereck V. Tapefunctionality: position, change in shape, and outcome after TVT procedure-mid-term results.Int Urogynecol J, 21: 795-800 (2010).Dietz H, Barry C, Lim Y, Rane A. TVT vs Monarc: a comparative study. Int Urogynecol J, 17:566-569 (2006).Dietz H, Wilson P. The Iris Effect: how 2D and 3D volume ultrasound can help usunderstand anti-incontinence procedures. Ultrasound Obstet Gynecol, 23: 267-271 (2004).Yang JM, Yang SH, Huang WC, Tzeng CR. Reliability of a new method for assessingurethral compression following midurethral tape procedures using four-dimensionalultrasound. Ultrasound Obstet Gynecol, 38: 210-216 (2011).