Efficacy of tolterodine in relation to different urodynamic findings of detrusor overactivity.

Aim of the study was to evaluate the efficacy of tolterodine in relation to different urodynamic findings of detrusor overactivity (DO). Women with urodynamic diagnosis of DO were prospectively included into two groups: with involuntary detrusor contractions during the cystometric filling phase (group 1) or after provocative manoeuvres (group 2). Tolterodine 4 mg ER was prescribed to all women. Drug efficacy was assessed using a 3-point scale. Women were defined responders if they were improved/cured after 3 months of therapy, and non-responders if symptoms did not change. The outcome of therapy was compared between groups. A total of 111 women were included. The groups did not differ for demographic characteristics. After 12 weeks, we found a significant difference (P = 0.0008) between groups in terms of tolterodine efficacy with a better response rate in group 1. Our study shows that tolterodine efficacy may be related to different urodynamic findings of DO.

Opening vesical pressure: a new test to discriminate urethral sphincter deficiency?

Urethral sphincter deficiency (USD) is not standardised. Opening vesical pressure could reflect the pressure exerted to overcome urethral resistance during void; thus, we evaluated if it could discriminate USD. Women with urinary symptoms were prospectively assessed with a questionnaire and urodynamics and divided into three groups: urodynamic stress incontinence with USD (group 1), urodynamic stress incontinence related to urethral hypermobility without USD (group 2) and normal urodynamic (group 3). USD was defined as the concomitant presence of severe urodynamic stress incontinence, VLPP <60 cm H2O, MUCP <20 cm H2O and urethral mobility <30 degrees . A total of 145 women were enrolled: 56 in group 1, 50 in group 2 and 39 in group 3. The three groups did not differ for demographics, obstetric and surgical history. The median values for opening vesical pressures were 17.5 (15.6-22.2 95%CI), 30 (27.0-37.3 95%CI) and 30 (30.6-44.2 95% CI) for the groups 1, 2 and 3, respectively. A p value <0.0001 was found when comparing group 1 either with group 2 or 3. Opening vesical pressure is a promising parameter to detect USD.

Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency.

The purpose of this study was to evaluate the outcome of tension-free vaginal tape (TVT) procedure in women with urodynamic stress incontinence diagnosed as having intrinsic sphincteric deficiency (ISD). The combination of a maximal urethral closure pressure < 20 cm H2O and a Valsalva leak point pressure < 60 cm H2O was considered as diagnostic of ISD. Subjects with detrusor overactivity on preoperative urodynamics were excluded. A total of 35 patients with both low closure pressure and leak point pressure were enrolled. Bladder perforation occurred in three (8.6%) cases. Postoperative urinary voiding difficulties occurred in nine (25.7%) women. Two patients underwent surgical detension of the tape, with complete resolution of urinary retention and no relapse of incontinence. Women with postoperative voiding dysfunction had a significantly lower detrusorial pressure at the peak flow on preoperative urodynamics compared to those who voided efficiently after TVT. The mean (range) follow-up time was 12.5 months (3-36). The objective cure rate for stress incontinence was 91.4%. Two of the three (66%) patients in whom the TVT procedure failed had a fixed urethra. De novo urge incontinence was found in five (14.3%) patients.

Impact of tension-free vaginal tape on sexual function: results of a prospective study.

The purpose of this study was to prospectively assess the impact of a TVT insertion for the treatment of stress urinary incontinence (SUI) on coital incontinence and overall sexual life. Sexually active women with pure SUI and without concomitant pelvic organ prolapse scheduled for TVT procedure completed a sexual function questionnaire at baseline and 6 months after surgery. Fifty-three patients were enrolled. Preoperatively 23 (43.4%) women experienced urine leakage during intercourse, 21 (91%) during penetration and 2 (9%) on orgasm. The objective cure rate for SUI was 98%. Coital incontinence was cured in 20 of 23 patients (87%). Thirty-three (62.2%) women reported no change in sexual function after surgery and 18 (34%) reported an improvement. Of the latter, 17 (94%) were of those cured from coital incontinence. No significant difference in the incidence of dyspareunia was found postoperatively. Two patients (3.8%) reported intercourse to be worse following surgery, one because of a vaginal erosion and one cited de novo anorgasmia as the main reason.

Influence of the type of anesthesia and hydrodissection on the complication rate after tension-free vaginal tape procedure.

OBJECTIVE: To evaluate the success rate of tension-free vaginal tape (TVT) performed under spinal and general anesthesia and to assess the efficacy of hydrodissection of the space of Retzius in reducing intraoperative and postoperative complications. STUDY DESIGN: A total of 149 patients, were enrolled. Of these, 53 patients underwent the TVT placement (alone or in combination with other pelvic surgery) under general anesthesia and 96 under spinal anesthesia. TVT placement was performed as originally described, apart from the hydrodissection of the space of Retzius, that was performed only in 82 cases. In the remaining 67 patients the TVT needles were introduced directly without hydrodissection. Postoperatively, the patients were scheduled for evaluation at 1, 3, 6 and 12 months. Cure was defined as no postoperative stress incontinence. RESULTS: Overall, the incidence of intraoperative and postoperative complications was 3.3% and 14.7%, respectively. No statistical difference was found in the intraoperative (1.9% versus 4.2%, P = 0.65) and postoperative complications (11.3% versus 16.7%) rates between the general and spinal anesthesia groups. No difference was found in the cure rate between groups (96.2% versus 95.8%). Similarly, no difference was found in the rate of intraoperative (3.7% versus 3.0%) and postoperative (15.9% versus 13.4%) complications between patients who had hydrodissection and those who did not. When the analysis was restricted to patients who underwent the TVT placement without concomitant surgery (n = 88), there was no difference in the incidence of intraoperative (2.1% versus 5.0%, P = 0.59) and postoperative complications (14.6% versus 15.0%, P = 1.0) between patients who had hydrodissection and those who did not. CONCLUSIONS: Efficacy and safety of the TVT procedure are not affected by the type of anesthesia (general or loco-regional). Hydrodissection of the space of Retzius during TVT placement does not reduce the risks of intraoperative complications.