Original Article

TFS posterior sling improves overactive bladder, pelvic pain and abnormal emptying, even with minor prolapse. A prospective urodynamic study

  • PETER PETROS
  • PETER A. RICHARDSON

Pelviperineology 2010;29(2):52-55

OBJECTIVE:

To prospectively challenge the Integral Theory’s predictions that female patients with even with minor degrees of prolapse, and who have a symptomatic overactive bladder (urgency, nocturia and frequency), are surgically curable with uterosacral ligament repair.

METHODS:

The study group comprised 67 patients with >2nd degree prolapse, with a subgroup of 27 symptomatic patients with only 1st degree prolapse. All patients were assessed pre and post-operatively by questionnaire, 24-hr urinary diary, transperineal ultrasound, urodynamics, cough stress and 24-hr pad test. Uterine/apical prolapse were repaired as a day case using the TFS. The TFS (‘Tissue Fixation System”) comprises an adjustable polypropylene ‘mini sling’ applied entirely per vagina, and which can be accurately tightened to reinforce loose or damaged pelvic ligaments.

RESULTS:

At median 9 months’ review, the percentage improvement rate in pre-operative dysfunctions for the total group is expressed as a percentage, with 1st degree in parenthesis: urinary frequency>10/day 63% (63%); nocturia >2/night 83% (76%); urge-incontinence >2/day 78% (76%); abnormal emptying, 73% (73%); pelvic pain, 86%(82%) fecal incontinence, 87% (100%).

CONCLUSIONS:

The posterior TFS sling is a promising minisling technique which appears to address symptoms such as urgency, nocturia, frequency, abnormal bladder emptying, and fecal incontinence, even in patients with minimal uterovaginal prolapse.

Keywords: TFS; Integral Theory; urge incontinence; overactive bladder; nocturia; pelvic pain; fecal incontinence.