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• W2315668097 abstract "When first-line management of stress urinary incontinence based on pelvic floor muscle retraining fails, surgical management is indicated. Placement of a surgical sling with a transobturator tape (TOT) or a retropubic tension-free vaginal tape (TVT) has medium-term and long-term efficacy for stress urinary incontinence. Insertion of the sling is associated with a variable incidence of pelvic pain ranging from 0% to 30%. A meta-analysis of 11 randomized, controlled studies comparing the 2 methods reported a higher rate of pain with the TOT (12%) than with the TVT procedure (1.3%). Few studies have investigated the pain induced by insertion of the sling, and there is no consensus on pain management. The pathogenesis of pain after insertion of the suburethral tape remains poorly understood. This prospective study assessed the functional results (changes in pain and continence) after removal of suburethral tape and also investigated the influence of the route of tape insertion on the incidence of pain. A total of 32 patients who were undergoing removal of suburethral tape, causing chronic pelvic and perineal pain, were prospectively followed between 2004 and 2009. The study subjects were divided into 2 groups based on the type of sling employed: group 1 (TOT, n = 15) and group 2 (TVT, n = 17). Tape removal for every patient in the TVT group was performed using transperitoneal laparoscopy. TOT group tape removal was performed through a transvaginal approach with an incision in the proximal painful thigh; the painful thigh was incised for unilateral pain, and both the thighs were incised for bilateral pain. Pain was assessed using a visual analog scale (VAS) which rated pain from 0 (no pain) to 10 (maximal pain) before surgery and during follow-up. In almost all patients, pelvic pain developed immediately or several days after surgery. Surgical removal of the tape in the TVT group showed an abnormal position or excessive traction of the tape in most patients (88%, 15/17). In the overall patient population, tape removal was associated with improvement of pain (at least 50% improvement in the VAS score) in 68% (22/32) of the patients at a mean follow-up of 10 months; the mean VAS score before and after surgery was 7.3 ± 1.5 and 3.4 ± 3, respectively. Pain relief was stable over time. There was no statistically significant difference between the 2 groups with respect to reduction of pain. Although recurrence of incontinence was observed after tape removal in 22% (7/22) of cases, incontinence was minimal in most cases (6 of 7). These findings show that surgical removal of suburethral tape improves pain in 68% of patients, with about a 20% risk of recurrence of urinary incontinence. There was no difference in pain relief between the TVT and TOT groups." @default.
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• W2315668097 date "2011-04-01" @default.
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• W2315668097 title "Functional Results After Tape Removal for Chronic Pelvic Pain Following Tension-Free Vaginal Tape or Transobturator Tape" @default.
• W2315668097 doi "https://doi.org/10.1097/ogx.0b013e318225c551" @default.
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