Tension FreeVaginal Tape .com | |||
Tension Free Vaginal Tape (TVT)orVisually Controlled Mini Vaginal Tape (MVT) ?
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Introduction: | |||
T.V.T. (tension free vaginal tape) is becoming the new "gold standard" in the surgical treatment of stress urinary incontinence. The old Burch's colposuspension with its side effects will probably disappear in the near future. TVT has been build on very relevant anatomic and physiopathologic data. But is it really the less expensive and the less dangerous way to obtain a distal, tension-free, solid, sub-urethral support? Read the next chapter before you answer this question.
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Visually Controlled Mini Vaginal Tape (MVT):
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| History It was in July 1985 that the first case of MVT was performed. Since then more than 600 cases have been accomplished by a single operator and more than 2000 cases have been completed both in France and Belgium by several surgeons. Principles Based on one anatomic logic similar to those developped later by Ulmsten and De Lancey, the MVT is predicated on similar physiologic principles. The technique entails placing under the middle urethra a mini-strip of synthetic tissue (mainly Gore-Tex®) the ends of which are then fastened to the anterior portion of the white line or more recently to the outer areas of the pubic arcuate ligament.
Endogenic tissue like fascia lata can also be used. Resorbable material
(PDS®) and collagen matrix (Pelvicol®
Afterwards, on each side, the para-urethral areas are dissected with wide scissors until feeling the pubic arcuate ligament. Then, with a constant visual control, stitches of Gore-Tex® threads set on a small but strong needle are passed, right and left, through the outer parts of the arcuate ligament.
Finally, this Gore-Tex® strip is fastened on each outer part of the pubic arcuate ligament and thus achieves a sub-urethral hammock.
The vaginal wall is then closed, with a vaginal plasty or not, by six to eight stitches of resorbable material.
All this procedure is usually performed within 20 to 30 minutes. Results In the single operator's series of 600 cases performed over a 15 year period, the failure rate is 9.9% after 1 year , 8.4% after 5 years, and 12.5% after 10 years. In our opinion, long term outcomes are due to the precision of the anatomo-physiological approach, the rigor of the
indications (selection of strict stress incontinence cases) and the use of synthetic tissue
capable of effectively replacing over the long term the deficient sub-urethral conjunctive
tissue. On the whole of 2000 cases, the percentages of rejection are higher function of the learning
curve of the operators, an unpublished pubic osteitis and two cases of urethral erosion were
pointed out but, as far as we know, without serious repercussions. In our mind, a solid training is the only method able to reduce the risks of these
complications. Compared to TVT the MVT, in addition to the benefit from using only one sling of synthetic
tissue 15 times smaller, has the advantage of being performed under constant visual control at
the expense of a minor suburethral dissection, which, at best, is only slightly bigger. Without"
a blind dimension to the procedure, it shows respect for the Retzius space and its vessels in
addition to be virtually void of any bladder risk.
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| References:
Title: [Fixation of Gore-Tex slings to the
pubococcygeal tendons: a simple technic of treating stress urinary
incontinence using only the vaginal approach] Title: [Surgical treatment of stress
urinary incontinence in women using a suburethral suspension with a
polytetrafluoroethylene sling. Apropos of 95 cases]
Intolérance au Gore-Tex. A propos de 86 soutènements
sous-urétraux |
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