"U-method" TVT-Secur slings: Are they obstructive?

Introduction: The TVT-Secur, a single incision sling, was introduced in 2006. It is implanted using either the "hammock" or the "U-method" technique. With the latter, the sling is tightened to create a "pillowing effect" on the urethra until a negative stress test is obtained. Short-term results seem promising. However, no study has ever reported on the voiding pattern 12 months after its implantation. Our objective was to assess whether the "U-method" technique creates an obstructive voiding pattern on pressure-flow study (PFS) 12 months after the surgery.

Methods: In this retrospective study, we reviewed the charts of 33 women who underwent the "U-method" TVT-Secur. Patients were evaluated before and 12 months postoperatively with regard to different urodynamic studies (UDS). The incontinence status was also assessed 12 months after surgery.

Results: At 12 months after the operation, 12.5% (4/32) of the patients reported an improvement of their stress urinary incontinence, while 78.1% (25/32) reported being cured from it. The objective cure rate was 63% (19/30). One patient had a suspected bladder outlet obstruction (BOO) based on PFS. Maximal flow rate (Q(max)) was significantly lower 12 months after surgery (26.0 mL/s [range: 19.0-36.5] vs. 21.5 mL/s [range: 16.0-32.3]). However, median voided volume was lower on the postoperative uroflowmetry (446 mL [range: 348-605] vs. 320 mL [range: 243-502]). Furthermore, none of the patients complained of voiding symptoms after surgery.

Conclusions: Although one patient had findings compatible with BOO, none complained of voiding symptoms. TVT-Secur may result in a lower Q(max). However, this finding may be due to a lower voiding volume on the postoperative UDS.