INTRODUCTION AND HYPOTHESIS: This study reports long-term outcomes of the transvaginal tension-free vaginal tape-obturator (TVT-O) procedure for treating stress urinary incontinence (SUI), including possible risk factors for failure.
METHODS: This was a retrospective study of women who underwent TVT-O with or without concomitant prolapse surgery. Procedures were performed at a tertiary referral urogynecology unit. Participants presented with SUI and had urodynamic stress incontinence (USI). Women with a history of previous anti-incontinence procedures, radical pelvic surgery, and detrusor overactivity (DO) were excluded. Objective cure was defined as absence of urine leakage during a cough stress test (CST). Subjective outcome was based on the International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Quality of life was assessed using the King's Health Questionnaire (KHQ). Univariate and multivariate analyses were used to identify risk factors for subjective failure.
RESULTS: One hundred twenty-four consecutive women were assessed, with a median follow-up of 90.3 (range 80-103) months. Overall objective and subjective cure rates were 81.5 % (101/124) and 83.5 % (103/124), respectively. A significant improvement was observed in all KHQ domains. Concomitant vaginal hysterectomy [odds ratio (OR) = 2.98, 95 % confidence interval (CI) 1.10-8.05, p = 0.03] and increasing point C (OR = 1.17, 95 % CI 1.05-1.30, p = 0.006] were associated with a higher risk for subjective failure. De novo urgency rate was 7 %.
CONCLUSIONS: The TVT-O procedure provides high objective and subjective long-term efficacy, a clinically meaningful improvement in patient quality of life, and an excellent safety profile. Concomitant vaginal hysterectomy and apical compartment prolapse were associated with a higher risk for objective and subjective failure.
Written by:
Athanasiou S, Grigoriadis T, Zacharakis D, Skampardonis N, Lourantou D, Antsaklis A. Are you the author?
First Department of Obstetrics and Gynecology, Urogynecology Unit, National & Kapodistrian University of Athens, "Alexandra" Hospital, 80 Vas. Sofias Avenue, 11528, Athens, Greece.
Reference: Int Urogynecol J. 2013 Jul 27. Epub ahead of print.
doi: 10.1007/s00192-013-2186-8
PubMed Abstract
PMID: 23892532
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