Reasons for dissatisfaction ten years after TVT procedure

A 10- to 20-year follow-up after tension-free vaginal tape for stress urinary incontinence

INTRODUCTION AND HYPOTHESIS

Midurethral slings (MUS) have become the gold standard in the treatment of stress urinary incontinence (SUI). Some information is already available on the outcome of tension-free vaginal tape (TVT) after 10 years or more. Our objective was to assess the current outcome (efficacy, adverse events) of women who had been successfully operated upon for SUI by means of a TVT procedure 10 to 20 years ago.

METHODS

We performed a retrospective cohort study including 291 women (mean age 69.4 years) who underwent a successful TVT procedure (retropubic bottom-to-top route) in a teaching hospital between January 2001 and December 2010. The main outcome measure was the incidence of SUI at 10-20 years' follow-up. Others were incidence of re-operation, tape exposure and de novo overactive bladder symptoms. We carried out a univariate logistic regression analysis to examine the relationship between outcomes and a set of clinical variables.

RESULTS

After a median of 15 years, TVT remains highly effective: 272 women (94%) experienced either no leakage under any circumstance (214=74%) or leakage less than weekly (58=20%). Mesh exposure (8=2.7%; 1.8 events per 1,000 patient-years) and repeat surgery for SUI (11=3.8%; 2.5 events per 1,000 patient-years) were low. Three women (1%) needed to perform intermittent self-catheterisation. Bothersome overactive bladder symptoms (45=15%) were common and associated with polypharmacy, cardiovascular medication and obesity.

CONCLUSION

The efficacy of TVT is demonstrated up to 20 years. The presence of bothersome OAB symptoms in the population may be an indicator of multimorbidity.

Is the adjustable TVA mesh effective for the long-term treatment of female stress incontinence?

OBJECTIVES

To assess the long-term safety and efficacy of the adjustable TVA mesh in treating stress urinary incontinence.

MATERIAL AND METHODS

Pseudoexperimental study, before and after, conducted in a university urology department. Eighty-two patients were invited to participate from January 2002 to March 2005. Thirty-two patients agreed to participate and were implanted an adjustable TVA mesh. The preoperative study included a medical history review, physical examination with full bladder, flowmetry, residue study, complete urodynamic study and the self-administered questionnaires I-QoL and ICIQ-SF. In the postoperative assessment, the PGI-I questionnaire was added, but a complete urodynamic study was not performed.

RESULTS

Twenty-nine (90.6%) and 28 (87.5%) patients were continent in the stress test at 1 and 10 years, respectively. Twenty (62.5%) and 16 (50%) patients had no urine escape at 1 and 10 years, respectively. Twenty-eight (87.5%) and 25 (78%) patients were satisfied 1 and 10 years after the surgery, respectively. Twenty-eight (87.5%) and 21 (62.5%) patients had a good quality of life at 1 year and at 10 years, respectively. There were no significant complications at the end of the study period.

CONCLUSIONS

Treatment of stress urinary incontinence with the TVA mesh presented a high degree of objective healing and satisfaction at 10 years, with no severe adverse effects. The study showed that satisfaction does not always mean total continence but rather it reflects the improvement of symptoms and consequent quality of life.

Patient and surgeon goal achievement 10 years following surgery for pelvic organ prolapse and urinary incontinence

INTRODUCTION AND HYPOTHESIS

Assessment of outcomes after pelvic floor surgery remains controversial. The primary aim of our study was to compare patient goal achievement in prolapse/continence surgery with objective/subjective outcomes. The secondary aim was to compare patient goal achievement with overall satisfaction and with that of the surgeon.

METHODS

This was a prospective longitudinal observational study, over 10 years, in a tertiary urogynaecology centre. Women with prolapse/stress incontinence undergoing surgery and surgeons listed five goals they hoped to achieve following surgery. The Pelvic Organ Prolapse Quantification System (POP-Q) and videocystourethrography (VCU) were used for objective assessment. Quality of life (QoL) was assessed using the Prolapse QoL (PQoL) questionnaire, the King's Health Questionnaire (KHQ) and Golombok Rust Inventory of Sexual Satisfaction (GRISS) and satisfaction with Patient Global Impression of Improvement (PGII).

RESULTS

Complete data were available for 96 women (47.76%). POP-Q scores significantly improved (p < 0.05); objective cure of incontinence (VCU) was 84.7%. QoL questionnaires and PGII scores showed significant improvement (p < 0.01). Mean goal achievement was 83.2.1% for patients and 82% for surgeons. Patient goal achievement for prolapse surgery was observed sooner and correlated better with other measures of success than continence surgery. Continence-related goals based on symptom relief were achieved more frequently than those on body image and sexuality. Surgeons reported a high achievement rate in anatomical restoration and functional improvement goals.

CONCLUSIONS

Patient goal achievement correlates significantly with other measures of "success" as well as with overall satisfaction. Surgeons and patients have varying expectations of the outcome of surgery. Nearly 83% of goals are still maintained 10 years following surgery.