The Case Summary Analysis Of TVT-Secur In Treatment Of Stress Urinary Incontinence

Background:Tension-free vaginal slings are thought to be the first-line treatment in surgery of stress urinary incontinence (SUI). Clinically there are two approaches prevalently used-the retropubic TVT and the transobturator TOT/TVT-O. Most recently, a new type of mini-invasive tape has been invented, named TVT-Secur. It is identical to the traditional TVT (U-shaped TVT-Secur) or TVT-O (Hammock TVT-Secur); and with a shorter length and a special-designed structure, it could reach an anchoring without any sutures or inserting needles, expecting to reduce the complications such as bladder perforation and postoperative pain theoretically. Despite its attractiveness in invasion, the initial results reported on TVT-Secur have been rather disappointing.Objective:To investigate the efficacy and safety of TVT-Secur in treatment of SUI, and make a preliminary comaprison between TVT-Secur and TVT/TVT-O.Methods:1,In this article, the published data about TVT-Secur are searched and summarized, from several aspects to analyze the efficacy and safety of TVT-Secur, such as the general conditions of patients, the peri-and post-operative complications, the short-term efficacy, and so on. Also a simple summary is made about the efficacy of H-and U-approaches of TVT-Secur and MUI.2,The data of TVT and TVT-O are also searched in order to make a simple comparison between TVT-Secur and the two.3,Because of the inconsistency in criterions of different papers and limited in randomized control trials, it is only a case summary descriptive analysis not a meta-analysis being be carried out here, which limits its scientificalness. Results:1,analysis of general conditions of patients in TVT-Secur:Aging,obesity,parity,menopause, etc, are risk factors of Urinary Incontinence. SUI and stress-predominant MUI are indications of TVT-Secur; UI/POP operation history,combined with a POP needed operation,urgent-predominant incontinence and severe ISD or urethral hypomobility, etc, are limitations of TVT-Secur.2,analysis of operation-related index of TVT-Secur:There are two approaches of TVT-Secur, H-and U-approach, which is chosen randomly or under the operator's choice. TVT-Secur can be operated under local anesthesia, the VAS postoperation is less than 2.5, with a 80-95% of patients'recommendation. The operative time is 10-30 mins, while the U approach with a longer time (35 mins vs 26 mins, respectively, p=0.0001).3,the safety of TVT-Secur:Perioperatively:injuries of surrounding tissue 0.86%, bleeding>100ml 0.86%, perioperative vioding difficulty 3.13%; 1-year fllow-up: voiding difficulty 1.58%, urgent symptoms 6.67%, recurrent or persistent incontinence 7.33%, tape erosion 3.67%, urinary tract infection 2.42%, dyspareunia 1%, groin discomfort or pain 0.75%.4,the efficacy of TVT-Secur:The objective cure rate is 70.3%-83.9%, while the subjective cure rate is 76.4%-79%.5,the comparison between two approaches of TVT-Secur:The objective cure rates of H-and U-approach are 80.1% and 87.5%, respectively(p=0.091); while the subjective cure rates are 75.7% and 77.1%, respectively(p=0.786); which show no significant difference.6,the comparison of TVT-Secur in differrent types of UI:TVT-Secur show a much lower 41.5% in MUI than SUI, while the approaches shows no significance.7,the summary analysis of TVT and TVT-O:The efficacies of TVT and TVT-O are 88.9%-94.6% and 88.4%-94.6%, respectively, with no significant difference. The operative time are 27-32.62mins and 16.6-19mins, respectively. The rate of bladder injuries in TVT is 2.7%-3.3%, while scarcely in TVT-O. The rates of postoperative complications are as follows:voiding difficulty 9.2%, urgent symptoms4.95%, tape-ralted complications 1.1%(0.6%-4.9%), postoperative pain4.0%.Conclusion:1,TVT-Secur as a new type of surgery in treatment of SUI, its safety is affirmative, with a significant decrease in the incidence of bladder perforation and postoperative pain, while voiding dysfunctions and tape erosion need further research.2,TVT-Secur is much disappointing with a significantly lower efficacy than TVT and TVT-O. There is no significant difference between U-and H-approaches. TVT-Secur is more effective in SUI than MUI.3,The long-term efficacy and complications of TVT-Secur still need further studies.