Ultrasound Assessment of Tension-Free Vaginal Tape (TVT)

Zusammenfassung

Ziel: Bislang konnte keine Standardisierung zur Beurteilung der Suburethralschlingen (TVT) etabliert werden. Die vorliegende Studie beurteilt die Form und Lage des Bandes und vergleicht die sonografischen Daten mit den postoperativen Ergebnissen. Material und Methoden: Wir konnten 296 Patientinnen in unserer Abteilung im postoperativen Verlauf nach Einlage eines TVT nachuntersuchen. Außerdem nahmen wir weitere 12 Patientinnen in die Studiengruppe auf, die außerhalb operiert wurden und sich aufgrund postoperativer Probleme bei uns vorstellten. Nach 3 Monaten wurden die Patientinnen in Gruppen mit postoperativen Problem oder ohne Störungen eingeteilt. Das TVT wurde mittels Introitussonografie beurteilt. Die Position des TVT wurde in Relation zur Urethralänge festgelegt. Außerdem wurde der Abstand des Tapes zum hypoechogenen Zentrum der Harnröhre vermessen. Ergebnisse: Die adäquate Lage des Bandes wurde in der Patientengruppe ohne postoperative Problem festgelegt. Das TVT befand sich in Ruhe in Relation zur Harnröhrenlänge im Mittel bei 61 %. Die Distanz zum hypoechogenen Zentrum der Urethra betrug 4,6 ± 1,5 mm. Bei persistierender Belastungsinkontinenz fand sich das TVT häufiger im Bereich des inneren (3 vs. 0 %) oder äußeren (29 vs. 13 %; p = 0,001) Harnröhrenviertels. Bei Patientinnen mit Restharnbildung lag das Band signifikant enger der Harnröhre an (2,7 vs. 4,6; p < 0,001). Schlussfolgerung: Die sonografische Kontrolle des TVT sollte regelmäßig durchgeführt werden. Diese Untersuchungsmethode erlaubt zusammen mit der klinischen Symptomatik eine verbesserte Planung von weiterführenden therapeutischen Maßnahmen bei postoperativen Problemen.

Abstract

Purpose: To date, no standardization for the visualization of tension-free vaginal tape (TVT) has been established in clinical practice. The aim of this prospective observational study was to evaluate the shape and position of the tape using ultrasound and to compare this data with clinical postoperative results. Materials and Methods: In a three-year period, 296 patients with clinically and urodynamically proven stress urinary incontinence (SUI) were treated with TVT and received follow-up in our department. An additional 12 patients, who were initially treated in other hospitals and had postoperative problems, were included in this study. Depending on the outcome after 3 months, the patients were divided into groups with and without specific disorders. The TVT was evaluated by introital ultrasound. The position of the tape was established by its location in relation to the urethral length and the distance to the hypoechoic center of the urethra (HCU). Results: A suitable TVT position was determined in patients without any postoperative disorders. The mean value for the TVT position at rest in relation to the urethral length was 61 %. The distance to the HCU was 4.6 ± 1.5 mm. In patients with persistent SUI, the tape was more often located under the inner (3 % vs. 0 %) or outer quarter (29 % vs. 13 %, p = 0.004). In patients with residual volume, the distance to the urethra was significantly lower (2.7 vs. 4.6, p < 0.001). Conclusion: TVT may be regularly investigated using ultrasound. In combination with the clinical outcome, it represents an important method of evaluating the tape and assists in the planning of a future therapeutic course of action in cases of postoperative problems.

Key words

ultrasound - TVT - tension-free vaginal tape

References

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