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The position of the urethrovesical junction after incontinence surgery: early postoperative changes

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Abstract

This study prospectively evaluated the position of the urethrovesical junction using the Q-tip angle to assess early postoperative changes for different anti-incontinence surgeries. All procedures resulted in a statistically significant change in resting angle from the intraoperative value. The mean change for the transvaginal tape was 25.74° (27.43 to 3.28); Burch 11.18° (−20.44 to −10.0) and fascia sling 13.9° (26.57 to 15.68). The mean change in Q-tip angle was greater after transvaginal tape placement than after Burch (p=0.000) and fascial sling (p=0.022) procedures. These findings show that the resting position of the urethrovesical junction after surgery is different for all procedures. The transvaginal tape results in the greatest change in angle. This may help to negate the so-called ‘tension-free’ nature of the procedure. Surgeons need to be aware of this, as it may be an etiological factor in cases of late urinary retention and urethral erosion.

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Author information

Authors and Affiliations

  1. Division of Urogynecology and Reconstructive Pelvic Surgery, Gynecology and Women’s Health , St. Louis University Department of Obstetrics, St. Louis, Missouri, USA

    Mary T. McLennan & Sara Cannon

  2. Division of Surgical Research, Greater Baltimore Medical Center, Baltimore, MD, USA

    Clifford F. Melick

Authors
  1. Mary T. McLennan
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  2. Clifford F. Melick
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  3. Sara Cannon
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Corresponding author

Correspondence to Mary T. McLennan.

Additional information

Editorial Comment: The authors present a prospective observational study which compares the changes in position of the urethrovesical junction measured in the immediate postoperative period and at 6 weeks in patients undergoing transvaginal tape procedures, the Burch procedure and fascial slings for urinary incontinence.

There was no attempt at randomization of subjects, and the study groups were poorly matched. Only 15% of the patients undergoing transvaginal tape procedures reported previous surgery for urinary incontinence, compared to 29% of those undergoing Burch procedures. The number of Burch procedures studied was comparatively small.

However, this study does provide evidence that there are significant postoperative changes in the position of the urethrovesical junction, which appear more marked for the transvaginal tape procedures than for the Burch or fascial sling procedures. This study also questions the ‘tension-free’ nature of the transvaginal tape procedures.

The findings from this study should be confirmed in a larger prospective randomized trial with longer patient follow-up.

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McLennan, M.T., Melick, C.F. & Cannon, S. The position of the urethrovesical junction after incontinence surgery: early postoperative changes. Int Urogynecol J 15, 44–48 (2004). https://doi.org/10.1007/s00192-003-1117-5

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  • DOI: https://doi.org/10.1007/s00192-003-1117-5

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