The impact of tension-free vaginal tape on the urethral closure function: Mechanism of action

TY - JOUR

T1 - The impact of tension-free vaginal tape on the urethral closure function

T2 - Mechanism of action

AU - Saaby, Marie-Louise

AU - Klarskov, Niels

AU - Lose, Gunnar

N1 - © 2013 Wiley Periodicals, Inc.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Aim To investigate if the tension-free vaginal tape (TVT) works by increasing the abdominal to urethral pressure impact ratio (APIR).Methods Twenty one women with urodynamically proven stress urinary incontinence (SUI) were assessed by ICIQ-SF, pad-weighing test, incontinence diary and Urethral Pressure Reflectometry (UPR) before and after TVT. UPR was conducted during resting and increased intra-abdominal pressure (PAbd) by straining. Related values of PAbd and urethral opening pressure (Po) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line was found. The slope expresses the ratio of pressure increase in the urethra compared to the pressure increase in the abdomen and was called APIR.Results The urethral opening pressure at rest (Po-rest) was unchanged after TVT, while APIR increased in all women (from 0.7 to 1.4, P < 0.0001).Conclusions The TVT seems to strengthen the urethral closure function by increasing the APIR while Po-rest is unchanged regardless of the type of pre-operative dysfunction. This confirms the theory of TVT's mechanism of action being mid-urethral support. Neurourol. Urodynam. 34:50-54, 2015.

AB - Aim To investigate if the tension-free vaginal tape (TVT) works by increasing the abdominal to urethral pressure impact ratio (APIR).Methods Twenty one women with urodynamically proven stress urinary incontinence (SUI) were assessed by ICIQ-SF, pad-weighing test, incontinence diary and Urethral Pressure Reflectometry (UPR) before and after TVT. UPR was conducted during resting and increased intra-abdominal pressure (PAbd) by straining. Related values of PAbd and urethral opening pressure (Po) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line was found. The slope expresses the ratio of pressure increase in the urethra compared to the pressure increase in the abdomen and was called APIR.Results The urethral opening pressure at rest (Po-rest) was unchanged after TVT, while APIR increased in all women (from 0.7 to 1.4, P < 0.0001).Conclusions The TVT seems to strengthen the urethral closure function by increasing the APIR while Po-rest is unchanged regardless of the type of pre-operative dysfunction. This confirms the theory of TVT's mechanism of action being mid-urethral support. Neurourol. Urodynam. 34:50-54, 2015.

KW - Adult

KW - Aged

KW - Female

KW - Humans

KW - Middle Aged

KW - Pressure

KW - Suburethral Slings

KW - Urethra

KW - Urinary Incontinence

KW - Urodynamics

U2 - 10.1002/nau.22513

DO - 10.1002/nau.22513

M3 - Journal article

C2 - 25296187

SN - 0733-2467

VL - 34

SP - 50

EP - 54

JO - Neurourology and Urodynamics

JF - Neurourology and Urodynamics

IS - 1

ER -