Better Short-term Outcomes With the U-Method Compared With the Hammock Technique for the Implantation of the TVT-SECUR Under Local Anesthesia
Received 8 September 2009; accepted 21 November 2009. published online 10 March 2010.
Objectives
To observe the satisfaction of local anesthesia during the implantation of the tension-free vaginal tape (TVT)-SECUR (Gynecare, Ethicon, Somerville, NJ) for the treatment of stress urinary incontinence, using questionnaires completed by the patients, and to evaluate the short-term safety and efficacy of the sling.
Methods
Forty-eight women were operated between January 2007 and October 2008. The implantation of the TVT-SECUR was done under local anesthesia by 1 surgeon. The “Hammock” technique was used in the first 23 patients and the “U-Method” in the last 25 patients.
Results
Mean patient age was 61 years (range, 38-85). Visual analogue scale for pain immediately and 1 week after surgery showed a mean score of 19/100 and 29/100, respectively. Overall, 93% (43/46) of the patients would recommend this type of anesthesia. At 1 week, 2 months, and 6 months after surgery, the improvement in incontinence symptoms rate was 82% (18/22), 76% (16/21), and 69% (11/16) for the Hammock technique, compared with 75% (18/24), 92% (22/24), and 100% (22/22) for the U-Method. At 6 months, the difference was statistically significant (P = .0087). Postoperative complications included 6 partial tape exposures, all with the Hammock technique.
Conclusions
Local anesthesia with light sedation represents an appropriate choice for the implantation of this new sling. The TVT-SECUR using the U-Method appears to be relatively safe, and the short-term efficacy rates seem to compare with traditional midurethral slings, with long-term efficacy still to be determined. This is the first report showing better outcomes of one technique over the other.
Service d'Urologie, Centre Hospitalier universitaire de Sherbrooke (CHUS), Université de Sherbrooke, Quebec, Canada
Reprint requests: Louis-Olivier Gagnon, M.D., Centre Hospitalier universitaire de Sherbrooke (CHUS), Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Quebec J1H 5N4, Canada
The study was supported by educational grant from Ethicon women's Health.
ABSTRACT