Tension-Free Vaginal Tape - Eine Literaturübersicht

Zusammenfassung

Einführung: Seit 1996 wird zur Inkontinenztherapie weltweit immer häufiger das TVT (tension-free vaginal tape) verwendet. Das Ziel dieser Studie war die Effektivität, Sicherheit und Komplikationen der TVT-Operation am Menschen im Sinne einer Literaturübersicht zu erfassen.

Material und Methoden: Es wurde eine Medline-Suche von Januar 1994 - Januar 2003, mit dem Suchbegriff: „tension free vaginal tape“ durchgeführt. Eingeschlossen wurden alle Artikel auf Englisch, Französisch und Deutsch.

Ergebnisse: Es fanden sich 106 Artikel. Die Erfolgsraten wurden zwischen 59 und 100 % angegeben. Häufige Komplikationen traten in bis zu 60 % auf und beinhalteten: Blasenperforationen, Blasenentleerungsstörungen, Harnwegsinfekte, De-novo-Urge, De-novo-Detrusorinstabilität, Blutungen, Hämatome, Schmerzen. Als seltene Komplikationen wurden in bis zu 3,3 % beschrieben: Erosion von Vagina, Urethra oder Blase, Vaginaverletzung, Urethraverletzung, Gefäßverletzung, Nervenläsion, Darmläsion, Urethrafistel, vesikovaginale Fistel, Wundinfekt, Wundheilungsstörung, Schlingenabstoßung, technische Probleme, Venenthrombose, akute Niereninsuffizienz, Sepsis, Herzinfarkt, Tod.

Schlussfolgerung: TVT ist ein sicheres erfolgreiches Verfahren zur Therapie der Inkontinenz mit guten mittelfristigen Ergebnissen. Wegen der zum Teil sehr unterschiedlichen Einschlusskriterien (Stressinkontinenz oder Stress-Urge-Inkontinenz, nur TVT oder kombinierte Operationen, Voroperationen), Definitionen (Heilung, Verbesserung, Komplikationen), Studienarten (nur 3 prospektiv randomisierte Studien) und Fallzahlen (19 Studien mit < 50 Patientinnen), ist eine einheitliche Beurteilung der Studien schwierig.

Abstract

Introduction: Since 1996, TVT (tension-free vaginal tape) is increasingly used worldwide for the treatment of urinary incontinence. The aim of this study is to review the effectiveness, safety and complications of the TVT operation in human subjects.

Material and Methods: We searched Medline for the term “tension free vaginal tape” for the period from January 1994 - January 2003. Included are all articles in English, French and German.

Results: A total of 106 articles was found. The success rate was reported to be between 59 % and 100 %. Frequent complications were found in up to 60 % of patients and included: bladder perforation, urinary retention, urinary tract infection, de novo urge incontinence, de novo detrusor instability, bleeding, haematoma, pain. Rare complications described in up to 3.3 % of cases included: erosion of the vagina, urethra or bladder, vaginal lesion, urethral lesion, vessel injury, nerve injury, bowel injury, urethral fistula, vesicovaginal fistula, wound infection, defective wound healing, sling rejection, technical problems, venous thrombosis, acute renal failure, septicaemia, myocardial infarction, death.

Conclusion: TVT is a safe and effective method for the treatment of urinary incontinence, with good short-term and middle-term results. Due to the lack of standardisation in the studies with respect to inclusion criteria (stress urinary incontinence or mixed incontinence, TVT only or in combination with other operations, previous operations), definitions of outcome, study design (only 3 prospective randomised studies) as well as sample size (19 studies with < 50 patients), it is difficult to interpret the results.

Schlüsselwörter

Tension-free vaginal tape

Key words

Tension-free vaginal tape

Literatur

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