Zur Effizienz von 'Tensionfree Vaginal Tape'® (TVT) als Therapie von Harnstressinkontinenz bei hypotoner Urethra

Purpose: Patients with stress urinary incontinence at low urethral closure pressure, defined as maximum closure pressure equal or lower than 20 cm H 2 O, are at a higher risk for failure of surgical intervention. The aim of the study was to evaluate the objective healing and the changes of the urethral closure pressure of such women with severe urinary stress incontinence at hypotone urethra undergoing tension-free vaginal tape procedure. Material and Methods: Out of 150 patients who underwent TVT procedure between May 1999 and August 2000 because of urinary stress incontinence we found 29 of them with hypotone urethra. 25 of these were followed up in this study. Condition for enclosure was a positive stress test (leakage of urine like a jet at filled bladder with 300 ml while coughing as well in lying as in standing position) and a maximum urethral closure pressure lower or equal to 20cm H 2 O 4-6 weeks before surgery while performing urodynamic examination. 7 (4-12) months after surgery urodynamics and stress test were repeated. Healing was defined as negative stress test and regular maximum urethral pressure (higher than 20 cm H 2 O) at the time of control. Results: 19 (76%) patients had a negative stress test and a regular urethral pressure. At 4 (16%) women we found a negative stress test and still a hypotone urethra although maximum urethral pressure had risen but not up to 20 cm H 2 O. One (4%) patient still had a positive stress test with regular urethral closure pressure and one (4%) patient had a positive stress test as well as a hypotone urethra. Over all 23 (92%) patients had a negative stress test and were healed of urinary stress incontinence in all day situation. Conclusion: Our dates confirm TVT as a minimal invasive procedure to cure urinary stress incontinence in women with low pressure of the urethra.