"U-method" TVT-Secur slings: Are they obstructive?

Area of Science:

• Urology
• Female Pelvic Medicine and Reconstructive Surgery

Background:

• The TVT-Secur, a single incision sling, was introduced in 2006 and can be implanted using the "hammock" or "U-method" technique.
• The "U-method" involves tightening the sling to create a "pillowing effect" on the urethra until a negative stress test is achieved.
• While short-term results are promising, long-term voiding patterns after the "U-method" TVT-Secur implantation remain underreported.

Purpose of the Study:

• To assess whether the "U-method" TVT-Secur technique results in an obstructive voiding pattern on pressure-flow study (PFS) 12 months post-surgery.
• To evaluate the long-term efficacy and safety of the "U-method" TVT-Secur for stress urinary incontinence.

Main Methods:

• Retrospective review of 33 women who underwent "U-method" TVT-Secur implantation.
• Urodynamic studies (UDS) and incontinence status assessment before and 12 months postoperatively.
• Analysis of pressure-flow studies (PFS) to evaluate voiding patterns and identify potential bladder outlet obstruction (BOO).

Main Results:

• High subjective cure rates (78.1%) and objective cure rates (63%) for stress urinary incontinence at 12 months.
• One patient (3%) showed findings compatible with bladder outlet obstruction (BOO) on PFS.
• Maximal flow rate (Qmax) was significantly lower postoperatively (21.5 mL/s vs. 26.0 mL/s), but median voided volume was also lower (320 mL vs. 446 mL).
• No patients reported voiding symptoms post-surgery.

Conclusions:

• The "U-method" TVT-Secur technique does not appear to cause significant obstructive voiding symptoms at 12 months, despite a potential decrease in maximal flow rate.
• The observed lower maximal flow rate may be attributed to a lower voided volume during postoperative urodynamic studies.
• The "U-method" TVT-Secur demonstrates favorable long-term outcomes for stress urinary incontinence with minimal impact on voiding function.