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[The solution of stress urinary incontinence in women by the TVT-S surgical method--correlation between the curative effect of this method and changes in ultrasound findings].

OBJECTIVE
The aims of this study were to compare ultrasonographic findings of the urethra and the tape position and mobility following the tension-free vaginal tape secure system (TVT-S) procedure and to correlate these data with clinical signs of cure and failure of this procedure in the treatment of stress urinary incontinence (SUI) in women. Another aim of our study was to determine indications for particular position of the tape (the "hammock" or "U" position) based on ultrasonographic findings of the urethra and the tape position following TVT-S.


DESIGN
Prospective, randomized study.


SETTINGS
Department of Gynecology and Obstetrics, First faculty of Medicine, Charles University and General Teaching Hospital, Prague.


MATERIALS AND METHODS
Analyses of the position of the urethra and the tape of 85 patients were performed using perineal ultrasonography. The efficacy of the TVT-S procedure was evaluated by cough test and by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-UI SF).


RESULTS
Objective assessment by cough test showed that 53 (62%) of our patients were completely dry, and in 32 (38%) patients leakage of urine persisted after the operation. From the US examination and results we can conclude that 3 months after the operation the mobility of the urethra and bladder neck are restricted. A correlation between cure effect and the restriction of the movement of the urethra was found between the position at the middle of the urethra before and after the operation. Subjective assessment of the cure effect of this operation by the ICIQ-UI SF questionnaires (n=81) showed that 39 (48%) of our patients were completely dry and 24 (30%) of patients improved, which means that in 42 (52%) patients leakage of urine persists after the operation. There are differences in the restriction of urethral mobility between the cured patients and those where leakage persisted. The middle of the urethra and UVJ are more restricted in movement in cured patients. We found no statistically significant differences between the US measurements of the position of the urethra of patients with the tape in the "hammock" and the "U" position. The only statistically significant difference found is a slightly higher tension of the "U" tape three months after the operation during the Valsalva maneuver; the median width of the tape in the "hammock" position is 10.1 mm, while in the "U" position it is 8.1 (Wilcoxon test p = 0.0056). There were six patients diagnosed with urgency de novo, without urge incontinence in this series. In seven cases we found vaginal erosion.


CONCLUSIONS
From the US examination and results we can conclude that after the TVT-S operation, mobility of the urethra and bladder neck is restricted. After comparing ultrasonographic findings of the urethra and the tape position following TVT- Secure we can determine that there is no certain indication for placement of the tape in the "hammock" or the "U" position. The cure effect for different positions of the tape is similar. In some respects the slightly higher tension of the tape in the "U" position suggests that this tape position may be preferred in patients with intrinsic sphincter defect (ISD) of the urethra. A comparison of the cure effect of the TVT-S procedure with other tape procedures suggests a lower cure effect of this operation.