Urethrovesical segment ultrasound for the efficacy evaluation of surgical treatment of stress urinary incontinence

Abstract

Hypothesis/Aims of study. At present, there is no doubt about the importance of the problem of female stress urinary incontinence (SUI) and the search for the best way to eliminate it. Sling operations in SUI treatment are the most popular in world and domestic practice. However, they are not without certain complications. In this regard, it becomes relevant to determine the factors for predicting their effectiveness and safety. The aim of this study was to conduct a comparative study of the effectiveness of two anti-stress operations: TVT-Obturator® and urethrovesicopexy with vaginal flap, by using echography of the urethrovesical segment.

Study design, materials and methods. During the period from 2011 to 2018, 105 incontinent patients were examined and operated on. Two groups were formed: Group 1 consisted of 52 patients who underwent TVT-Obturator® surgery, Group 2 included 52 patients who underwent urethrovesicopexy with vaginal flap. In all patients, the anatomical topographic position of the bladder and urethrovesical segment, the internal urethral sphincter status, as well as the angles α and β were determined, based on which the conclusion about the type of SUI was made and, accordingly, the adequate method of surgical intervention was determined.

Results. Before the operation, the angle α averaged 37.2 ± 10.11, with 24.7 ± 4.64 a year after the operation and 26.8 ± 3.72 five years after the operation. Rotation of the angle α in the study groups >20° before surgery did not significantly affect the presence of long-term complications, urinary retention after a year and five years, and recurrence of urinary incontinence. After the operation, there was an increase in the angle β after a year (p = 0.0032) and five years (p = 0.0035) and in the total urethral length after a year (p = 0.0022), but after five years, this parameter did not differ significantly from that before surgery (p = 0.29).

Conclusion. TVT-Obturator® and urethrovesicopexy with vaginal flap are equally effective (p > 0.05) in the surgical treatment of female SUI in both the nearest postoperative period (96.2% and 94.3%, respectively) and the distant period (90.4% and 88.7%, respectively).

Keywords

stress urinary incontinence / TVT-Obturator® / vaginal flap / urethrovesicopexy / urethrovesical segment ultrasound

RIGHTS & PERMISSIONS

Kira K.E., Bezhenar V.F., Prokhorova V.S.