Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
International Urogynecology Journal
Published in: International Urogynecology Journal 3/2007

01-03-2007 | Original Article

Funneling before and after anti-incontinence surgery—a prognostic indicator? Part 2: tension-free vaginal tape

Authors: Lena Harms, Günter Emons, Werner Bader, Rainer Lange, Reinhard Hilgers, Volker Viereck

Published in: International Urogynecology Journal | Issue 3/2007

Login to get access

Abstract

Does the presence of pre- and postoperative funneling of the proximal urethra affect the outcome of tension-free vaginal tape (TVT)? This prospective study of 191 women with proven primary genuine stress urinary incontinence treated by TVT insertion and assessed by pre- and postoperative introital ultrasound aims to answer that question. At 36-month follow-up, the cure rate was 89.5% (Kaplan–Meier estimator). At 6-month follow-up, 6.3% of the women had urge symptoms and 0.5% de novo urge incontinence. The cure rate in preoperative funneling was 77.5% as opposed to 96.6% in the group without funneling (P<0.0001). The funneling rate significantly decreased from 37.2% preoperatively to 17.3% immediately postoperatively (P<0.0001). The continence rate was 57.5% in persistent postoperative funneling vs 96.2% in the group without postoperative funneling (P<0.0001). The complication rate was not higher in the group with persistent postoperative funneling. The TVT procedure significantly reduces bladder neck funneling. Both preoperative and persistent postoperative funneling are associated with an increased probability of therapeutic failure or recurrence.
Literature
1.
Petros P, Ulmsten U (1990) An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand 153:7–31
2.
Ulmsten U, Hendriksson L, Johnson P, Varhos G (1996) An ambulatory surgical procedure under local anaesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 7:81–86PubMedCrossRef
3.
Nilsson CG, Rezapour M, Falconer C (2004) Seven-year follow-up of the tension-free vaginal tape (TVT) procedure. Am J Obstet Gynecol 104:1259–1262
4.
Rezapour M, Ulmsten U (2001) Tension-free Vaginal Tape (TVT) in women with recurrent stress urinary incontinence—a long-term follow-up. Int Urogynecol J Pelvic Floor Dysfunct 2:9–11CrossRef
5.
Rezapour M, Falconer C, Ulmsten U (2001) Tension-free vaginal tape (TVT) in stress incontinent woman with intrinsic sphincter deficiency (ISD)—a long-term follow-up. Int Urogynecol J Pelvic Floor Dysfunct 2:12–14CrossRef
6.
Rezapour M, Ulmsten U (2001) Tension-free vaginal tape (TVT) in women with mixed urinary incontinence—a long-term follow-up. Int Urogynecol J Pelvic Floor Dysfunct 2:15–18CrossRef
7.
Schaer GN, Koechli OR, Schuessler B, Haller U (1995) Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence. Obstet Gynecol 85:220–224PubMedCrossRef
8.
Schaer G, Koelbl H, Voigt R, Merz E, Anthuber C, Niemeyer R, Ralph G, Bader W, Fink D, Grischke E (1996) Recommendations of the German Association of 9. Urogynecology on functional sonography of the lower female urinary tract. Int Urogynecol J Pelvic Floor Dysfunct 7:105–108PubMedCrossRef
9.
Schaer G, Perucchini D, Munz E, Peschers U, Koechli OR, Delancey JOL (1999) Sonographic evaluation of the bladder neck in continent and stress-incontinent women. Obstet Gynecol 93:412–416PubMedCrossRef
10.
Dietz HP (2004) Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol 23:80–92PubMedCrossRef
11.
Skala C, Emons G, Krauss T, Hilgers R, Gauruder-Burmester A, Lange R, Bader W, Viereck V (2004) Postoperative funneling after anti-incontinence surgery—a prognostic indicator? Part 1: colposuspension. Neurourol Urodyn 2004 23:636–642CrossRef
12.
Huang WC, Yang JM (2003) Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence: a sign associated with urethral hypermobility and intrinsic sphincter deficiency. Urology 61:936–941PubMedCrossRef
13.
Tunn R, Petri E (2003) Introital and transvaginal ultrasound as the main tool in the assessment or urogenital and pelvic floor dysfunction: an imaging panel and practical approach. Ultrasound Obstet Gynecol 22:205–213PubMedCrossRef
14.
Viereck V, Pauer HU, Bader W, Oppermann, M, Hilgers R, Gauruder-Burmester A, Lange R, Viereck N, Emons G, Hackenberg, R, Krauss T (2004) Introital ultrasound of the lower genital tract before and after colposuspension: a 4-year objective follow-up. Ultrasound Obstet Gynecol 23:277–283PubMedCrossRef
15.
Tunn R, Schaer G, Peschers U, Bader W, Gauruder A, Hanzal E, Koelbl H, Koelle D, Perucchini D, Petri E, Riss P, Schuessler B, Viereck V (2005) Updated recommendations on ultrasonography in urogynecology. Int Urogynecol J Pelvic Floor Dysfunct 16:236–241PubMedCrossRef
16.
Abrams P, Blaivas JG, Stanton SL, Andersen JT (1990) The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Br J Obstet Gynaecol 97:1–16
17.
Kelleher CJ, Cardozo LD, Khullar V, Salvatore S (1997) A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 104:1374–1379PubMed
18.
Olsson I, Kroon UB (1999) A three year postoperative evaluation of tension-free vaginal tape. Gynecol Obstet Invest 48:267–269PubMedCrossRef
19.
Ulmsten U, Johnson P, Rezapour M (l999) A three-year follow up of tension-free vaginal tape for surgical treatment of female stress urinary incontinence. Br J Obstet Gynaecol 106:344–350
20.
Kuuva N, Nilsson CG (2002) A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 81:72–77PubMedCrossRef
21.
Liapis A, Bakas P, Creatsas G (2002) Burch colposuspension and Tension-free vaginal tape in the management of stress urinary incontinence in women. Eur Urol 41:469–473PubMedCrossRef
22.
Virtanen HS, Kiilholma P (2002) Urogynecologic ultrasound is a useful aid in the assessment of female stress urinary incontinence–a prospective study with TVT procedure. Int Urogynecol J Pelvic Floor Dysfunct 13:218–223PubMedCrossRef
23.
Sarlos D, Kuronen M, Schaer GN (2003) How does tension-free vaginal tape correct stress incontinence? Investigation by perineal ultrasound. Int Urogynecol J Pelvic Floor Dysfunct 14:395–398PubMedCrossRef
24.
Tunn R, Goldammer K, Gauruder-Burmester A, Wildt B, Beyersdorff D (2005) Pathogenesis of urethral funneling in women with stress urinary incontinence assessed by introital ultrasound. Ultrasound Obstet Gynecol 26:287–292PubMedCrossRef
25.
Schaer GN, Koechli OR, Schuessler B, Haller U (1995) Improvement of perineal sonographic bladder neck imaging with ultrasound contrast medium. Obstet Gynecol 86:950–954PubMedCrossRef
26.
Schaer GN, Koechli OR, Schuessler B, Haller U (1996) Perineal ultrasound: determination of reliable examination procedures. Ultrasound Obstet Gynecol 7:347–352PubMedCrossRef
27.
Dietz HP, Clarke B (2001) The urethral pressure profile and ultrasound imaging of the lower urinary tract. Int Urogynecol J Pelvic Floor Dysfunct 12:38–41PubMedCrossRef
28.
Bettin S, Fischer W, Tunn R (2000) TVT-Plastik bei Harninkontinenz. Erfahrungen der Charité-Frauenklinik. Gynakol Praxis 24:305–320
29.
Koelle D, Windisch J, Doerfler D, Marth C, Kropshofer S (2006) Effect of tension-free vaginal tape operation on urethral closure function. Urology 67:524–529PubMedCrossRef
30.
Valpas A, Kivela A, Penttinen J, Kauko M, Kujansuu E, Tomas E, Haarala M, Meltomaa S, Nilsson CK (2003) Tension-free vaginal tape and laparoscopic mesh colposuspension in the treatment of stress urinary incontinence: immediate outcome and complications—a randomized clinical trial. Acta Obstet Gynecol Scand 82:665–671PubMedCrossRef
31.
Wang AC, Chen MC (2003) Comparison of tension-free vaginal taping versus modified Burch colposuspension on urethral obstruction: a randomized controlled trial. Neurourol Urodyn 22:185–190PubMedCrossRef
Metadata
Title
Funneling before and after anti-incontinence surgery—a prognostic indicator? Part 2: tension-free vaginal tape
Authors
Lena Harms
Günter Emons
Werner Bader
Rainer Lange
Reinhard Hilgers
Volker Viereck
Publication date
01-03-2007
Publisher
Springer-Verlag
Published in
International Urogynecology Journal / Issue 3/2007
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI
https://doi.org/10.1007/s00192-006-0147-1

Other articles of this Issue 3/2007

International Urogynecology Journal 3/2007 Go to the issue

Original Article

Age effects on anorectal pressure in anal continent women with lower urinary tract dysfunction

Original Article

Perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures

Original Article

The utility of magnetic resonance imaging for diagnosis and surgical planning before transvaginal periurethral diverticulectomy in women

Current Opinion/Update

The empty bladder

Case Report

Incisional hernia after a tension-free vaginal tape procedure

Original Article

Tension-free vaginal tape sling for recurrent stress incontinence after transobturator tape sling failure