Monday, July 18, 2011

Complications of TVT vs TVT-O slings; Which is Better or Worse, or Are They the Same?

Modern slings for the treatment of stress urinary incontinence took a huge technological step forward after the TVT was invented and debuted in 1996. The “tension free vaginal tape” (TVT) is a narrow mesh sling that goes under the urethra and supports it during exercise, running, coughing, laughing, etc, in order to prevent leakage of urine during these activities.
Over the years there have been many variations of the TVT, and many companies have copied the method of placing this sling, and have also developed new methods for placing slings. Variations develop because of some dissatisfaction with the original concept. So in 2001, the TVT-O was developed. It is placed sideways through the pelvis, instead of behind the pubic bone. Is this difference relevant?

Many studies comparing these 2 methods have been performed and the latest one reviewed 1081 patients from Russia. Group 1 consisted of women undergoing the TVT, while Group 2 underwent the TVTO. All the entry criteria for the women were equal between the two groups, except that Group women had a slightly higher BMI.

Both sling approaches have equal efficacy in treating stress urinary incontinence as has been shown in many prior studies as well as in this study, but this study was specifically looking at complication details.
In the women who received a TVT there were higher rates of hematomas (large bleeding) (9.1% vs 1.5%), and bladder injury (5.4% vs 0.6%), vs the TVTO, while the women who received the TVTO had a higher rate of injuring the vagina (3.8% vs 0) compared to TVT. If the injuries are recognized during the surgery by the astute surgeon, then they can be dealt with immediately.
Importantly, the risk of urinary dysfunction (trouble with too strong an urge, or weak stream, or not emptying the bladder) were higher in the TVT group. This is not news and is expected given prior research, but the chance of developing NEW urge incontinence and NEW overactive bladder were at least 3-4 times higher in the TVT group.

Ultimately, the best method to treat stress incontinence is based on the patient’s condition, pre-operative assessment, and which surgery is most successful in your surgeon’s hands. Make sure to ask your surgeon which slings they have done and would they feel comfortable handling complications should they occur.