Synthetic Midurethral Slings: TVT and TOT

Whereas laparoscopic retropubic colpopexy was the minimally invasive surgical procedure of choice in the late 1990s, the use of TVT has quickly become the preferred minimally invasive technique in the treatment of stress urinary incontinence. The rapid acceptance of the use of tension-free vaginal tape is quite understandable. Few techniques in gynecologic surgery have been as well studied.

Rapidly accumulating data indicate that the long-term results are at least as good as the standard, retropubic colpopexy. In a large, multicenter, prospective, randomized trial for stress urinary incontinence (Am. J. Obstet. Gynecol. 2004;190:324–31), the cure rates at 2 years for TVT and colposuspension were essentially the same (81% vs. 80%).

For this edition of the Master Class, I am proud to have Dr. Mickey M. Karram discussing TVT in the treatment of stress urinary incontinence. As one of the true thought leaders in urogynecology, Dr. Karram helped introduce the use of TVT in the United States.

Dr. Karram is the director of urogynecology and reconstructive pelvic surgery and the director and founder of the fellowship training program in female pelvic medicine and reconstructive surgery in the department of obstetrics and gynecology at Good Samaritan Hospital in Cincinnati. He is also affiliated with the department of obstetrics and gynecology at the University of Cincinnati and is editor-in-chief of the International Urogynecology Journal and Pelvic Floor Dysfunction.

Dr. Karram has authored over 90 peer-reviewed publications and 33 book chapters, and has edited five books. I am truly honored to have Dr. Karram introduce the important topic of synthetic midurethral slings for stress incontinence.