Jean-François Hermieu | Search PubMed

PubMed2003

[Bladder injury after TVT transobturator].

The new minimally invasive technique for surgical treatment of female stress urinary incontinence via a transobturator approach is designed to reconstitute the urethral support sling while preserving the retropubic space. One of the advantages of this technique is that it avoids the risk of bladder injuries, frequently observed during passage of TVT into the prevesical space, particularly when it has been previously operated. However, recent anatomical studies have shown that bladder injuries may still occur with the use of this new transobturator approach. The present case is the first published case reporting a bladder injury during transobturator insertion of TVT.

Female↗

PubMed2003

[Complications of the TVT technique].

Since the first description of the TVT technique in 1995 by Ulmest, more than 300,000 TVT procedures have been performed worldwide, essentially in Europe. This technique appears to be safe and effective. Based on analysis of large published series with sufficient follow-up, it is now possible to define the various complications, establish their incidences, identify their causes and implement ways to avoid or possibly treat these complications. Bladder perforation is frequent, pelvic haematomas and haemorrhagic complications, and urethral or vaginal erosions are rare. Postoperative urinary retention occurs in 5% to 10% of cases. Voiding disorders (dysuria, de novo urge incontinence, and frequency) have also been reported. The other complications include nerve lesions, pain, dyspareunia, urinary tract infections, urethrovaginal or vesicovaginal fistulas. Serious complications such as vascular wounds or intestinal lesions are rare. Only 4 deaths have been reported to date.

Female↗

PubMed2003

[Synthetic suburethral sling in the treatment of stress urinary incontinence in women].

Since the marketing and success of the TVT technique, other products have been released onto the suburethral sling market. These products can be classified according to four main criteria: TAPE: The material used in every case is polypropylene, in the form of woven monofilaments (TVT, Sparc, Monarc, Uretex Sup), multi-filaments (IVS, Safyre comprising two silicone tension bands), extruded crosslinked polypropylene (Obtape) or silicone-coated polypropylene in contact with the urethra (Uratape). A larger space between the fibres is associated with a lower theoretical risk of infection and better tissue ingrowth. The weaving process of Uretex Sap tape decreases the warping and release effect. Extruded polypropylene forms a very solid, but poorly elastic tape. It is not yet clear whether silicone-coating is an advantage or a disadvantage. INCISION: The ascending retropubic approach (TVT, Uretex Sup, IVS) is now well known. It carries a risk of bladder perforation and, more exceptionally, intestinal or vascular injuries. The descending retropubic approach (Uretex Sup, Sparc) requires more extensive vaginal dissection and carries a risk of bladder perforation. The mixed retropubic approach (Uretex Sup) combines the potential disadvantages of the ascending and descending approaches. The transobturator approach (Uratape, Obtape, Monarc) was described more recently and is easy to learn. It does not carry any risk of intestinal or vascular injury, but the urethra, vagina or even the bladder (in the case of lateral cystocele) can be damaged by this incision. INSTRUMENTS: Ease of use is an essential feature. Uretex Sup comprises ancillary instruments and a technique requiring multiple manipulations. Sparc tape cannot be easily dissociated from the ancillary instruments when a second passage is necessary. TVT and Uratape use resterilizable instruments, while the other products are totally disposable. FOLLOW-UP AND PUBLICATIONS: Only TVT has a sufficient follow-up and several hundred specific papers or publications. Only a few publications by a few different teams are currently available for the other products. In conclusion, the various published studies confirm the qualities and good tolerance of woven monofilament polypropylene. The other materials require a longer follow-up and more studies before they can be completely validated in terms of results and morbidity. The multiple surgical approaches and the various ancillary instruments available allow the technique to be adapted to each patient and each surgeon, regardless of his or her initial training and habits.

Biocompatible Materials↗

PubMed2002

[Interstitial cystitis].

Interstitial cystitis is a disease characterized by pain occurring as the urinary bladder is gradually filling up. Its pathophysiology is unknown. The cause could be either a membrane permeability disorder, a mast cell disturbance in the bladder wall, or an autoimmune process involving the bladder. The diagnosis is essentially clinical but endoscopies and biopsies are required to rule out vesical cancers. Treatments is difficult and based on a combination of sanitary and dietary regimens, as well as drugs administered orally or infused within the bladder. Surgical treatment must remain exceptional.

Adult↗