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Keslar M, Margossian H, Katz JE, Lakhi N. A comprehensive look at risk factors for mid-urethral sling revision surgery. Int Urogynecol J 2020; 31:779-784. [PMID: 32034459 DOI: 10.1007/s00192-020-04233-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study was to identify risk factors and urodynamic parameters predictive of mid-urethral sling (MUS) revision surgery that can be used for counseling patients and individualizing risk prediction. METHODS Retrospective case-control analysis of 40 sling revisions performed during the 12-year study period were compared to 123 control cases that did not require revision to obtain a 1:3 case-to-control ratio. Demographic, perioperative, and urodynamic data were analyzed, with p < 0.05 as significant. Independent predictors of sling revision were assessed by binary logistic regression models, with risk expressed as adjusted odds ratios. RESULTS After multiple regression analysis, younger age at time of index MUS placement (aOR 0.93, 95% CI 0.88-0.97), increasing number of cesarean deliveries (CD) (aOR 2.00, 95% CI 1.01-3.96), and concomitant apical prolapse repair during index MUS procedure (aOR 4.63, 95% CI 1.34-15.93) were significant predictors of sling revision. CONCLUSIONS Young age at the time of placement, multiple CD, and concomitant apical prolapse repair were independent factors predictive of sling revision. Giving consideration to risk factors could improve patient counseling and surgical candidate selection.
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Affiliation(s)
- Melissa Keslar
- Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA.
| | - Haroutyoun Margossian
- Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA
| | - Justin E Katz
- Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA
| | - Nisha Lakhi
- Department of Obstetrics and Gynecology, Richmond University Medical Center, 355 Bard Avenue, Staten Island, NY, 10310, USA.,New York Medical College, Valhalla, NY, USA
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Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial. Wideochir Inne Tech Maloinwazyjne 2019; 15:18-29. [PMID: 32117482 PMCID: PMC7020724 DOI: 10.5114/wiitm.2019.84702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/16/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction The midurethral sling has become the current standard for the treatment of female stress urinary incontinence. Aim To assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures. Material and methods The analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6- and 12-month follow-up. Results A significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13–0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16–0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97–6.3; OR = 2.3, 95% CI: 0.95–5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality. Conclusions TVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.
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Engen M, Svenningsen R, Schiøtz HA, Kulseng-Hanssen S. Mid-urethral slings in young, middle-aged, and older women. Neurourol Urodyn 2018; 37:2578-2585. [PMID: 30178571 DOI: 10.1002/nau.23583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 03/04/2018] [Indexed: 11/10/2022]
Abstract
AIMS To compare subjective and objective outcomes of mid-urethral sling (MUS) surgery in women in different age decades and the utilization rates for MUS in Norwegian women. METHODS Data from the national Norwegian Female Incontinence Registry on 21 832 women with stress or mixed urinary incontinence who underwent MUS surgery from 1998 to 2016 were used. Primary outcomes were treatment satisfaction and absence of objective stress leakage at 6-12 months follow-up and "MUS utilization rate." Secondary outcomes were increase in urgency incontinence symptoms and surgical complications. RESULTS Women in the sixth decade and older had more objective postoperative stress urinary leakage, and women in the seventh decade and older were less satisfied. Urgency incontinence symptoms (persistent and de novo) after MUS increased with age. Intermittent catheterization occurred significantly more often in the seventh decade and bladder perforation in the seventh and eighth decades. Women younger than the fifth decade had fewer complications, except the need for tape transection in the fourth decade. The "MUS utilization rate" increased in all age groups during the study period, but declined slightly in the oldest age group after 2010. CONCLUSION All age groups had a high percentage of "very satisfied" and no objective stress leakage at 6-12 months follow-up, but declining slightly with age after the sixth decade. Urgency incontinence symptom bother increased with age, but the overall complication rates were low. Our study strengthens the argument that management of stress urinary incontinence with MUS seems suitable regardless of age.
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Affiliation(s)
- Madeleine Engen
- Department of Obstetrics and Gynecology, Baerum Hospital, Baerum, Norway
| | - Rune Svenningsen
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - Hjalmar A Schiøtz
- Department of Obstetrics and Gynecology, Vestfold Hospital Trust, Tønsberg, Norway
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Ellington DR, Erekson EA, Richter HE. Outcomes of Surgery for Stress Urinary Incontinence in the Older Woman. Clin Geriatr Med 2015; 31:487-505. [PMID: 26476111 PMCID: PMC4609316 DOI: 10.1016/j.cger.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
As population demographics continue to evolve, specifics on age-related outcomes of stress urinary incontinence interventions will be critical to patient counseling and management planning. Understanding medical factors unique to older women and their lower urinary tract conditions will allow caregivers to optimize surgical outcomes, both physical and functional, and minimize complications within this population.
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Affiliation(s)
- David R. Ellington
- University of Alabama at Birmingham, Division of Urogynecology and Pelvic Reconstructive Surgery, 176 F Suite 10382, 619 19 Street South, Birmingham, Alabama 35249-7333, Phone: (205)-934-1704, Fax: (205)-975-8893,
| | - Elisabeth A. Erekson
- The Geisel School of Medicine at Dartmouth, Division of Female Pelvic Medicine and Reconstructive Surgery, 1 Medical Center Dr., Lebanon, NH 03756, Phone: (603) 653-9312, Fax: (603) 650-0906,
| | - Holly E. Richter
- University of Alabama at Birmingham, Division of Urogynecology and Pelvic Reconstructive Surgery, 176 F Suite 10382, 619 19 Street South, Birmingham, Alabama 35249-7333
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Gibson W, Wagg A. Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data. BJOG 2015; 123:1386-92. [DOI: 10.1111/1471-0528.13338] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 11/27/2022]
Affiliation(s)
- W Gibson
- Division of Geriatric Medicine; University of Alberta; Edmonton AB Canada
| | - A Wagg
- Division of Geriatric Medicine; University of Alberta; Edmonton AB Canada
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Bing MH, Gimbel H, Greisen S, Paulsen LB, Soerensen HC, Lose G. Clinical risk factors and urodynamic predictors prior to surgical treatment for stress urinary incontinence: a narrative review. Int Urogynecol J 2014; 26:175-85. [PMID: 25248411 DOI: 10.1007/s00192-014-2489-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/06/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Knowledge about clinical risk factors and the value of urodynamic testing is important to optimize treatment strategy and secure true informed consent. METHODS We reviewed the relevant literature to clarify the evidence regarding clinical risk factors and the predictive value of urodynamic testing in patients with urinary incontinence, where surgery is considered. Because of the paucity of evidence based on randomized controlled trials, we conducted a narrative review of the published literature. RESULTS Clinical risk factors in terms of mixed urinary incontinence, previous incontinence surgery, body mass index (BMI) ≥ 35, age ≥ 75, and presence of diabetes mellitus were significantly related to decreased outcome of incontinence surgery. Furthermore, noninvasive and invasive urodynamic parameters indicating detrusor overactivity, voiding difficulties, low urethral pressure, and bladder-neck immobility were related to poorer outcome of surgery. CONCLUSIONS This study summarized the available evidence regarding preoperative clinical risk factors and urodynamic parameters indicating decreased or adverse outcome of surgery, and this report also provides clinical recommendations.
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Affiliation(s)
- Mette Hornum Bing
- Department Gynecology/Obstetrics, Herlev University Hospital, Herlev, Denmark,
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Jun KK, Oh SM, Choo GY, Park HK, Paick SH, Lho YS, Kim HG. Long-term clinical outcomes of the tension-free vaginal tape procedure for the treatment of stress urinary incontinence in elderly women over 65. Korean J Urol 2012; 53:184-8. [PMID: 22468214 PMCID: PMC3312067 DOI: 10.4111/kju.2012.53.3.184] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Accepted: 01/25/2012] [Indexed: 12/05/2022] Open
Abstract
Purpose The aim of this study was to assess the long-term clinical outcomes of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) in elderly women and to identify the factors influencing failure in these cases. Materials and Methods Women with SUI who underwent a TVT procedure were studied. "Cure" was defined as no urine leakage at all in any circumstances and "improvement" was defined as some urine leakage but a score of over 4 points out of 5 in a satisfaction inquiry. Patients were divided into two groups (middle-aged, <65 years and elderly, ≥65 years) for comparison of clinical outcomes. In the elderly group, patients were subdivided into two groups (cure and no cure groups) and were compared to identify the factors influencing failure. Results A total of 136 women (middle-aged group, 106; elderly group, 30) were enrolled in the study. The mean ages of the patients in the 2 groups were 53.5±5.9 and 72.0±5.0 years and the mean follow-up times were 50.5±9.4 and 48.8±9.1 months, respectively. The cure and improvement rates in the middle-aged and elderly groups were 80.2% vs. 66.7% and 4.7% vs. 3.3%, respectively (p>0.05). The satisfaction scores in the middle-aged and elderly groups were 3.8±1.1 vs. 3.3±1.5 points (p>0.05). In the elderly group, the body mass index of the cure and no cure groups were 24.6±3.3 kg/m2 and 26.6±1.0 kg/m2, and body mass index was the only factor that differed significantly between the two subgroups (p=0.028). Conclusions Our long-term results suggest that TVT is an effective treatment even in elderly women. However, elderly women who are obese should be counseled carefully about the success rate.
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Affiliation(s)
- Kyung Kyu Jun
- Department of Urology, Konkuk University School of Medicine, Seoul, Korea
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Hermieu JF, Bron J, Momper W, Dessard P, Roumier X, Devins CO, Wiecek W, Sorba G. [Stress urinary incontinence treatment using Surgimesh® Sling, evolution on patient quality of life and sexual activity during 12 months follow-up]. Prog Urol 2011; 21:554-61. [PMID: 21872159 DOI: 10.1016/j.purol.2011.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 04/21/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Evaluation of quality of life (QOL) and sexual activity after using sub-urethral Surgimesh® Sling for female stress urinary incontinence (SUI). METHODS Study with a total duration of 12 months. One hundred and sixty-eight patients presenting a SUI underwent surgery for a Surgimesh® Sling implantation. RESULTS QOL was significantly improved on the International Consultation Continence Questionnaire (ICIQ) scale with an increase of the average score from 2.79±1.75 to 8.48±1.7 at 12 months (P<0.05). The percentage of patients undergoing sexual intercourses remains at a high level during the study (76.87% versus 78.33%). The number of patients with pain during sexual intercourse significantly decreased (15% versus 2.1%). The QOL score is significantly better in post-operation conditions (7.84 versus 9.20; P=0.001). In terms of continence at 12 months, 75.6% of women declared recovery and 23.53% observed improvements. CONCLUSION SUI correction using Surgimesh® Sling induces a very significant improvement in patients' QOL and sexual activity.
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Affiliation(s)
- J-F Hermieu
- Chirurgie Urologique, Hôpital Bichat-Claude-Bernard, 46 Rue Henri-Huchard, 75877 Paris, France.
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Groutz A, Cohen A, Gold R, Pauzner D, Lessing JB, Gordon D. The safety and efficacy of the “inside-out” trans-obturator TVT in elderly versus younger stress-incontinent women: A prospective study of 353 consecutive patients. Neurourol Urodyn 2011; 30:380-3. [PMID: 20665549 DOI: 10.1002/nau.20976] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Asnat Groutz
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Fong EDM, Nitti VW. Review article: Mid-urethral synthetic slings for female stress urinary incontinence. BJU Int 2010; 106:596-608. [PMID: 21050350 DOI: 10.1111/j.1464-410x.2010.09544.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
• Mid-urethral synthetic slings (MUSS) have grown in acceptance and popularity to gain a foremost position in stress urinary incontinence (SUI) surgery. • There are numerous studies that provide a large amount of Level 1 and 2 evidence that support the concept of a sling placed at the level of the mid-urethra. • Long-term follow-up has been published for the original tension-free vaginal tape (TVT) procedure with the most recent publication providing Level 2 evidence with mean follow-up of 11.5 years of 69/91 (77%) of patients from the original series. There was objective cure was in 90% of women and 77% considered themselves subjectively cured, based on the Patient Global Impression of Improvement. • Level 1 evidence with long-term follow-up has been provided comparing colposuspension to TVT at 2 and 5 years. At 5 years for the primary efficacy variable of a negative 1 h stress pad test, there was no difference in success (81% vs 90%). • Two recent meta-analyses provide Level 1 evidence comparing outcomes for retropubic vs transobturator MUSS. One included 18 studies, randomized and cohort: cohort studies had a 12.3% failure rate for transobturator and 13.7% failure for the retropubic approach, randomized studies showed 5.7% failure in the transobturator vs 7.8% in the retropubic group. The other meta-analysis included 11 studies published 2008-2009, which found that the short-term cure rate was borderline inferior for the transobturator tape group (odds ratio 0.62; 95% confidence interval 0.37-1.00), nearly reaching statistical significance (P= 0.05). • This review details further comparator evidence and evidence for use in specific patient groups (elderly, obese, intrinsic sphincter deficiency, mixed UI).
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Affiliation(s)
- Eva D M Fong
- Department of Urology, New York University Langone Medical Center, New York, NY 10016, USA
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11
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[Sub-urethral sling in the treatment of female urinary incontinence: which? how?]. ACTA ACUST UNITED AC 2010; 38:607-19. [PMID: 20880735 DOI: 10.1016/j.gyobfe.2010.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Accepted: 05/03/2010] [Indexed: 11/23/2022]
Abstract
Review of the literature that formed the basis for drafting the guideline on the sub-uretral sling in the first-line surgical treatment of female stress urinary incontinence. Medline database query since the introduction of TVT on the questions of various chapters and sub-chapters of the present article. The use of tapes made of polypropylene monofilament exclusively, knitted, is recommended to the exclusion of any other material. Regarding the choice of procedure, the objective cure rate of transobturator and retro-pubic routes cannot be evaluated clearly because of vague evaluation criteria from one study to another. Without adequate clinical trials proving their efficacy and safety, the mini-bands can so far be recommended to treat female stress urinary incontinence. Moderate overweight does not affect the results of laying tape. In patients with severe obesity, surgery to correct obesity is even better than surgery for incontinence. Age is not a contra-indication. If the patient is young and nulliparous, it is reasonable to advise her to postpone surgery after her last pregnancy. In case of multiparous patient, the risk of vaginal delivery does not seem sufficient to suggest a cesarean section. To conclude, sub-urethral slings are the first-line surgical treatment of female stress urinary incontinence.
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Stav K, Dwyer PL, Rosamilia A, Schierlitz L, Lim YN, Lee J. Midurethral sling procedures for stress urinary incontinence in women over 80 years. Neurourol Urodyn 2010; 29:1262-6. [PMID: 20878996 DOI: 10.1002/nau.20862] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Kobi Stav
- Department of Urogynaecology (affiliated to Melbourne University), Mercy Hospital for Women, Melbourne, Victoria, Australia.
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Hermieu JF, Debodinance P. Recommandations pour le traitement chirurgical de l’incontinence urinaire d’effort de la femme par bandelettes sous-urétrales. Prog Urol 2010; 20 Suppl 2:S112-31. [DOI: 10.1016/s1166-7087(10)70006-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Debodinance P, Hermieu JF, Lucot JP. Traitement chirurgical de première intention de l’incontinence urinaire d’effort de la femme. ACTA ACUST UNITED AC 2009; 38:S182-200. [DOI: 10.1016/s0368-2315(09)73578-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Holmgren C, Hellberg D, Lanner L, Nilsson S. Quality of life after tension-free vaginal tape surgery for female stress incontinence. ACTA ACUST UNITED AC 2009; 40:131-7. [PMID: 16608811 DOI: 10.1080/00365590510031309] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To undertake a long-term follow-up evaluation of the quality of life (QOL) of women who had undergone a tension-free vaginal tape (TVT) procedure. MATERIAL AND METHODS During the period 1995-2001, 970 women with urinary stress incontinence underwent TVT surgery at the Department of Obstetrics and Gynecology, Falun Hospital. A questionnaire was mailed on average 5.7 years after the TVT procedure. Two incontinence-specific QOL instruments--the Incontinence Impact Questionnaire-7 (IIQ-7) and the Urogenital Distress Inventory-6 (UDI-6)--were administered. An additional questionnaire included general questions and questions about chronic diseases that may be associated with urinary incontinence. RESULTS The mean age at surgery was 58.7 years (range 29-89 years). Of 913 eligible women, 768 (78.9%) responded. Mean IIQ-7 and IDU-6 scores as estimated by the women improved dramatically at follow-up as compared to preoperative values: from 43.7 to 11.5 for the IIQ-7 and from 54.2 to 24.0 for the UDI-6 on a scale from 0 to 100 (p = 0.0001 for both). There were few differences in mean QOL scores even 8 years after TVT surgery, compared to those determined a shorter time after the operation. Women with diabetes, chronic constipation, chronic bronchitis and preoperative recurrent urinary infections had a relative improvement in QOL of the same magnitude as that of the remaining study population. Advanced age was negatively associated with an improvement in QOL scores. CONCLUSIONS Improvements in measures of QOL after TVT surgery are dramatic and persist for years. Women with concomitant diseases that may be associated with urinary incontinence can be assured that there is a good chance of success with TVT surgery.
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Affiliation(s)
- C Holmgren
- Department of Obstetrics and Gynecology, Falun Hospital, Falun, Sweden.
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Accuracy of recall in quality-of-life assessment among women operated on for stress urinary incontinence. Int Urogynecol J 2009; 20:1233-41. [PMID: 19513575 DOI: 10.1007/s00192-009-0917-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study is to assess the validity and reliability of a retrospective quality-of-life (QOL) assessment. METHODS The Incontinence Impact Questionnaire (IIQ-30) and the Short-Form Health Survey (SF-12) were self-administered pre-operatively. At 3 months post-op, the IIQ-30 and SF-12 surveys were mailed to patients to reassess their pre-operative QOL status. Pearson's correlation coefficient (r) and the intraclass correlation coefficient (ICC) were used to test the validity and reliability of the recalled IIQ and SF-12 scores. RESULTS Recall validity was excellent for the IIQ-30 (r = 0.64) and moderate for the SF-12 (r = 0.46 (physical component summary or PCS) and 0.42 (mental component summary or MCS)). Recall reliability was moderate with the IIQ-30 (ICC = 0.62) and poor with the SF-12 (ICC = 0.44 (PCS) and 0.49 (MCS)). CONCLUSIONS The IIQ-30 can be reliably used in a retrospective manner among women who have undergone surgery for SUI 3 months earlier.
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Factors predictive of outcome in tension-free vaginal tape procedure for urinary stress incontinence in a teaching hospital. Int Urogynecol J 2009; 20:775-80. [DOI: 10.1007/s00192-009-0851-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Accepted: 02/18/2009] [Indexed: 11/29/2022]
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Barber MD, Kleeman S, Karram MM, Paraiso MFR, Ellerkmann M, Vasavada S, Walters MD. Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings. Am J Obstet Gynecol 2008; 199:666.e1-7. [PMID: 19084098 DOI: 10.1016/j.ajog.2008.07.050] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/19/2008] [Accepted: 07/21/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The objective of the study was to identify predictors of recurrent urinary incontinence (UI) 1 year after treatment with tension-free vaginal tape (TVT) and transobturator tape (TOT). STUDY DESIGN One hundred sixty-two women with urodynamic stress urinary incontinence (SUI) were included in a clinical trial comparing TVT with TOT with at least 1 year of follow-up were included in this analysis. Potential clinical and urodynamic predictors for development of "any recurrent UI" or "recurrent SUI" 1 year after surgery were evaluated using logistic regression models. RESULTS Subjects who received concurrent prolapse surgery and those taking anticholinergic medications preoperatively were more likely to develop any recurrent UI. Increasing age was independently associated with recurrent SUI. Risk factors were similar for TVT and TOT for both definitions of treatment failure. CONCLUSION Concurrent prolapse surgery and preoperative anticholinergic medication use are associated with increased risk of developing recurrent UI 1 year after TVT or TOT. Increasing age is specifically associated with the recurrence of SUI symptoms.
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Two-year outcomes after surgery for stress urinary incontinence in older compared with younger women. Obstet Gynecol 2008; 112:621-9. [PMID: 18757661 DOI: 10.1097/aog.0b013e31818187c2] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate whether perioperative and postoperative outcomes after Burch colposuspension or pubovaginal sling for stress urinary incontinence (SUI) differed with age. METHODS This study was a prospective secondary analysis of the Stress Incontinence Surgical Treatment Efficacy Trial. Baseline characteristics, adverse events, and 2-year outcomes of women at least 65 years old were compared with those younger than 65 years using chi(2) and t tests. Multivariable analyses were performed, including age and outcomes that differed between age groups on univariable analysis, adjusting for variables that differed by age group at baseline and by surgical treatment group. RESULTS Six-hundred fifty-five women were included in analyses of perioperative events and 520 for 2-year outcomes. Mean age (+/-standard deviation) was 69.7 (+/-3.7) years in the older group and 49.4 (+/-8.2) in the younger group. Older women had slightly longer time to normal activities (50 days compared with 42 days, P=.05), but there was no difference in time to normal voiding (14 days compared with 11 days, P=.42). Older women were more likely to have a positive stress test at follow-up (odds ratio [OR] 3.7, 95% confidence interval [CI] 1.70-7.97, P=.001), less subjective improvement in stress (8 point lesser decrease, 95% CI 1.5-14.1, P=.02), and urge incontinence (7 point lesser decrease, 95% CI 1.5-12.2, P=.01) by the Medical and Epidemiologic Social Aspects of Aging questionnaire, and were more likely to undergo surgical retreatment for SUI (OR 3.9, 95% CI 1.30-11.48). Perioperative adverse events and length of stay did not differ between groups. CONCLUSION Older women undergoing surgery for stress incontinence can expect to do as well as younger women with respect to perioperative outcomes, but experience 2-year outcomes that are worse.
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Gerten KA, Markland AD, Lloyd LK, Richter HE. Prolapse and incontinence surgery in older women. J Urol 2008; 179:2111-8. [PMID: 18423726 DOI: 10.1016/j.juro.2008.01.089] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Indexed: 12/23/2022]
Abstract
PURPOSE Pelvic floor disorders including urinary incontinence, pelvic organ prolapse and fecal incontinence are common problems encountered by the older woman. With the increasing population of older American women urologists and gynecologists can expect to provide evaluation and treatment of these conditions with increasing frequency. These conditions are amenable to medical and surgical therapies. MATERIALS AND METHODS Contemporary articles (2003 to the present) that included older women undergoing urogynecological surgery were included in this review. Current data on morbidity, mortality and/or surgical outcomes are presented with evidence based preoperative, intraoperative and postoperative surgical management strategies. RESULTS Older women undergoing pelvic floor surgery can expect operative risks as well as subjective and objective anatomical and quality-of-life outcomes similar to those of younger women. CONCLUSIONS The decision for surgical intervention for the treatment of pelvic floor disorders should not be based on chronological age alone. Before selecting a specific surgical procedure, all existing pelvic floor defects should be evaluated. Further research is required to understand the impact that surgery for pelvic floor disorders has on anatomical, physiological and functional outcomes in older women.
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Affiliation(s)
- Kimberly A Gerten
- Department of Obstetrics and Gynecology, Division of Women's Pelvic Medicine and Reconstructive Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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Abstract
Pelvic floor disorders including urinary incontinence, pelvic organ prolapse, and fecal incontinence are common problems encountered by the older woman. With the increasing population of older Americans, healthcare providers can expect to provide evaluation and treatment of these conditions with increasing frequency. These conditions are amenable to both medical and surgical therapies. The older woman who undergoes surgery can expect similar risks and outcomes to that of younger women. Further research is required to more fully understand the functional, anatomic, and physiologic outcomes after treatment for pelvic floor disorders in the older woman.
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Affiliation(s)
- Kimberly A Gerten
- Department of Obstetrics and Gynecology, Division of Women's Pelvic Medicine and Reconstructive Surgery, University of Alabama at Birmingham, USA.
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Pozowski J, Sobański A, Dudkiewicz D, Michalski B, Ulman-Włodarz I. Quality of life in women with urinary stress incontinence and evaluation of tension-free vaginal tape treatment. Gynecol Obstet Invest 2007; 64:55-60. [PMID: 17287606 DOI: 10.1159/000099373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 12/18/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Assessment of quality of life in women stress urinary incontinence (USI) and evaluation of tension-free vaginal tape (TVT) treatment. MATERIAL AND METHODS The research included a group of 112 women aged 33-78 years. Before as well as 3 and 6 months after the TVT operation, patients were asked to fill in quality of life questionnaires. RESULTS After 3 months 87.25% of the women reported full regression of USI symptoms, 7.8% an insignificant improvement, and 4.9% did not observe any change. After 6 months 85.71% reported full regression, 9.18% an insignificant improvement, and 5.1% did not observe any change. USI is responsible for a decrease in physical activity. The most uncomfortable symptom is involuntary urine leakage occurring mainly during an effort or sleep. After the TVT procedure, the majority of women confirmed a significant improvement in quality of life. CONCLUSIONS The TVT procedure is an effective method of treating USI in women: it significantly improves quality of life, with a recovery rate of 85-87%, and a low rate of complications.
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Affiliation(s)
- Janusz Pozowski
- Clinical Department of Gynecology and Obstetrics, Silesian Medical Academy, Tychy, Poland
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Muller M, Koebele A, Deval B. [Determinants of success and recurrence after suburetral free tape procedure for female urinary incontinence]. ACTA ACUST UNITED AC 2007; 36:19-29. [PMID: 17293249 DOI: 10.1016/j.jgyn.2006.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/25/2006] [Accepted: 11/28/2006] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To provide a critical assessment on the tension free vaginal tape procedure used to support the urethra in female urinary incontinence. MATERIAL AND METHODS We identified articles related to Tension free vaginal tape through a MEDLINE search of English published literature from May 1998 to May 2006. Randomised control trial (RCTs) and retrospective clinical trials were selected including 478 publications on TVT (Tension-free Vaginal Tape), 55 on TOT) (Transobturator Tape), 17 on SPARC (Supra Pubic Arc), 2 on TPP) (Pre Pubic TVT). For the analysis of the functional results of the tape were not available: papers with a mean follow-up under 6 months, the invitation papers or non reviewed manuscript, the redundant papers in the same department, specific case control study. RESULTS/DISCUSSION Preoperative age over 70years old and morbid obesity do not seem to be a risk factor for failure of the TVT procedure; however, there is an increase of de novo urgency for age over 70 years old and BMI over 35. Suburetral tape procedure is highly effective in women with intrinsic sphincter deficiency. The urethral hypermobility increases the efficacy of the procedure, however women with fixed urethra, are at significantly increased risks for failure of the procedure. In the same way, preoperative mixed urinary incontinence and voiding difficulties alter the success rate of the procedure. The mode of anaesthesia and the topography of the tape (retropubic or transobturator) have no incidence on the results. There is a definite learning curve (n=20) for the efficiency and the morbidity of the procedure. Cranial topography of the tape and associated procedures are associated with urgency and voiding difficulties. CONCLUSION The prognosis factors having an effect on the success of the procedure are the urethral mobility, the mixed urinary incontinence, the learning curve, and the type of protheses.
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Affiliation(s)
- M Muller
- Département de Chirurgie Gynécologique, Maternité Universitaire de Nancy, France.
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Campeau L, Tu LM, Lemieux MC, Naud A, Karsenty G, Schick E, Corcos J. A multicenter, prospective, randomized clinical trial comparing tension-free vaginal tape surgery and no treatment for the management of stress urinary incontinence in elderly women. Neurourol Urodyn 2007; 26:990-4. [PMID: 17638307 DOI: 10.1002/nau.20440] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AIMS The aim of our study was to test the hypothesis that elderly women undergoing tension-free vaginal tape surgery (TVT) will have a better quality of life (QOL) and satisfaction compared to non-treated women despite age- and technique-related potential morbidity. METHODS This multicenter, prospective, randomized, controlled trial enrolled a total of 69 women aged over 70 years who initially consented to be randomized to either undergo immediate TVT surgery or to wait for 6 months before submitting to the same surgery (control group). The main outcomes measured at every visit (pre-randomization, 8-12 weeks and 6 months) consisted of the Incontinence-Quality of Life (I-QOL) Questionnaire, the Patient Satisfaction Questionnaire and the Urinary Problems Self-assessment Questionnaire, among others. RESULTS The analysis included 31 patients in the immediate surgery group and 27 subjects in the control group. Peri-operative complications in the immediate surgery group were bladder perforation (22.6%), urinary retention (12.9%), urinary tract infection (3.2%) and de novo urgency (3.2%). At 6 months, the mean I-QOL scores for the TVT and control groups were respectively 96.5 +/- 15.5 and 61.6 +/- 19.8 (P < 0.0001); mean Patient Satisfaction scores were respectively 8.0 +/- 2.7 and 2.0 +/- 2.4 (P < 0.0001); and mean Urinary Problems scores were respectively 4.5 +/- 4.3 and 11.6 +/- 3.5 (P < 0.0001). CONCLUSION At 6 months post-randomization, the group of elderly women who underwent immediate TVT surgery showed a significant improvement in QOL, patient satisfaction and less urinary problems compared to the group of women waiting for the same surgery.
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Affiliation(s)
- L Campeau
- Department of Urology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Canada
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Abstract
PURPOSE OF REVIEW To review recently published studies on stress urinary incontinence surgery outcomes in older women. RECENT FINDINGS Five prospective and two retrospective studies were identified that reported tension-free vaginal tape (n = 6), colposuspension (n = 1) and cadaveric fascia transvaginal sling (n = 1) procedure results. In each study, 21-175 older women were included, with mean ages ranging from 71 to 83 years; most studies included younger comparison groups. Mean follow-ups ranged from 3 to 30 months. Subjective stress urinary incontinence 'cure/improvement' rates after surgery were significantly lower in older women when compared with younger women in only one study, although similar trends were seen in two additional studies. Intraoperative complications occurred at similar rates in older and younger women. Postoperative complications (urinary tract infection, urgency, voiding dysfunction, and mesh erosion) were more common in older women in only a few studies. SUMMARY Recent studies demonstrate that surgery for stress urinary incontinence in older women improves symptoms, although in some reports, not to the extent seen in younger women. It is unclear if some postoperative complications are more common in older women undergoing incontinence surgery. Results from randomized trials focusing on stress urinary incontinence surgery in older women are needed.
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Affiliation(s)
- Victoria J Sharp
- Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA
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Dalpiaz O, Primus G, Schips L. SPARC Sling System for Treatment of Female Stress Urinary Incontinence in the Elderly. Eur Urol 2006; 50:826-30; discussion 830-1. [PMID: 16687203 DOI: 10.1016/j.eururo.2006.04.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 04/18/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of the suprapubic arch (SPARC) sling procedure for the management of stress urinary incontinence (SUI) in elderly women. METHOD Forty-three women, aged 65-91 yr, underwent the SPARC procedure for urodynamic SUI. Before surgery, a complete medical history was obtained and a urogynecology examination and urodynamic test were performed. The objective cure rate was evaluated by clinical and urodynamic examination at 3, 6, and 12 mo and the subjective cure rate was assessed using a visual analogue score and a global patient impression questionnaire. RESULTS No severe intraoperative or postoperative complications occurred. No patient referred de novo urge incontinence. Significant differences were found between the preoperative and postoperative number of daytime voidings (p < 0.001), the pad weights and numbers of pads used (p < 0.001), and the visual analogue score (p = 0.021). No significant differences in preoperative and postoperative urodynamic parameters were reported. At the mean follow-up of 36+/-14 mo (range, 12-54 mo), objective and subjective cure rates were 91% and 95%, respectively. CONCLUSIONS The SPARC procedure is effective and offers a satisfactory cure rate without significant morbidity in elderly women with SUI.
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Affiliation(s)
- Orietta Dalpiaz
- Medical University Graz, Department of Urology, Auenbruggerplatz 7, 8036 Graz, Austria.
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Atiemo H, Griebling TL, Daneshgari F. Advances in geriatric female pelvic surgery. BJU Int 2006; 98 Suppl 1:90-4; discussion 95-6. [PMID: 16911612 DOI: 10.1111/j.1464-410x.2006.06301.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Humphrey Atiemo
- Center for Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Abstract
Pelvic organ prolapse (POP) and urinary incontinence (UI) are common problems facing the geriatric woman. Many patients may find great benefit from medical or conservative treatments; however, surgical options are commonly used in many cases. This article examines the current medical and surgical innovations for POP and UI that have the potential to improve the patient's quality of life.
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Affiliation(s)
- Humphrey Atiemo
- Female Pelvic Medicine and Reconstructive Surgery, Glickman Urological Institute, The Cleveland Clinic, 9500 Euclid Avenue/A100, Cleveland, OH 44195, USA
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Ku JH, Oh JG, Shin JW, Kim SW, Paick JS. Age Is Not a Limiting Factor for Midurethral Sling Procedures in the Elderly with Urinary Incontinence. Gynecol Obstet Invest 2006; 61:194-9. [PMID: 16465064 DOI: 10.1159/000091321] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 12/11/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The object was to evaluate clinical outcome of the midurethral sling procedures in the elderly compared with middle-aged women. METHODS A total of 266 women who underwent midurethral sling procedures with at least follow-up greater than 6 months were included in the study. Patients were divided as the elderly group (65 years old or older, n = 60) and the middle-aged group (45-64 years old, n = 206). RESULTS Although postoperative urge symptoms were more prevalent in the elderly group (25.0%) than in the middle-aged group (6.3%), there were no significant differences between the two groups for the rates of postoperative urge incontinence (p = 0.159). Stress incontinence was cured by 91.3% in the middle-aged group and 85.0% in the elderly group, respectively (p = 0.158). CONCLUSIONS Age does not seem to be a significant risk factor for failure of midurethral sling procedures.
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Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Korea
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Gordon D, Gold R, Pauzner D, Lessing JB, Groutz A. Tension-free vaginal tape in the elderly: is it a safe procedure? Urology 2005; 65:479-82. [PMID: 15780359 DOI: 10.1016/j.urology.2004.09.059] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2004] [Accepted: 09/28/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To analyze the safety and efficacy of tension-free vaginal tape (TVT) surgery in elderly versus younger women with stress urinary incontinence (SUI). METHODS A total of 157 consecutive elderly women, aged 70 years and older, and 303 younger women (mean age, 74.8 and 57.2 years, respectively) who underwent TVT for urodynamically-confirmed SUI were prospectively enrolled. Concomitant genitourinary prolapse repair was performed in 84% of the elderly and 67% of the younger women. The main outcome measures were perioperative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction. RESULTS The incidence of TVT-related morbidity was similar in both groups, except for significantly fewer cases of bladder perforation among elderly women (1.3% versus 4.9%, P <0.05). However, some age-related morbidity was noted among the elderly women: 2 cases of pulmonary embolism, 2 cases of cardiac arrhythmia, 1 case of severe pneumonia, and 1 case of deep vein thrombosis. The outcome analysis was restricted to 123 elderly and 208 younger women with follow-up of at least 12 months (mean, 30 +/- 12 months; range, 12 to 67 months). The incidence of persistent postoperative SUI and persistent urge incontinence was similar in both age groups. However, de novo urge incontinence was significantly more common among elderly women (18% versus 4%, P <0.05). Two elderly and three younger women had postoperative pressure-flow studies suggestive of bladder outlet obstruction. CONCLUSIONS Tension-free vaginal tape surgery in elderly women is associated with good outcome results; however, the risk of postoperative de novo urge incontinence, as well as age-related morbidity, is increased.
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Affiliation(s)
- David Gordon
- Urogynecology and Pelvic Floor Unit, Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Schraffordt Koops SE, Bisseling TM, Heintz APM, Vervest HAM. Urogynaecology: Quality of life before and after TVT, a prospective multicentre cohort study, results from the Netherlands TVT database. BJOG 2005; 113:26-9. [PMID: 16398767 DOI: 10.1111/j.1471-0528.2005.00809.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To asses the long term outcome of tension-free vaginal tape procedure in women with isolated stress urinary incontinence (SUI). DESIGN Prospective cohort study. SETTING Twenty-eight teaching hospitals and 13 local hospitals, with 54 gynaecologists and urologists performing the surgery. SAMPLE Eight hundred and nine participants. METHODS The Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6) were used to measure the results of the TVT procedure (pre-operative at 2, 6, 12 and 24 months post-operative). According the recommendation of the International Continence Society (ICS), the question 'Do you experience urinary leakage during physical activity, coughing or sneezing?' was selected from the UDI to asses SUI. MAIN OUTCOME MEASURES Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6). RESULTS Both IIQ and UDI mean scores decreased significantly after TVT, indicating an improvement in quality of life. Subjective improvement can improve for up to two years post-operatively. CONCLUSIONS This is the largest prospective study that used these validated disease-specific questionnaires to asses the long term outcome of the TVT procedure. This study shows a statistically significant and clinically relevant long term improvement of the quality of life after a TVT for women with SUI.
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Abstract
PURPOSE OF REVIEW The aim of this article is to review the year's literature on the treatment of female incontinence with suburethral slings. RECENT FINDINGS The use of slings to treat female stress urinary incontinence has had resurgence with new surgical techniques. The tension-free vaginal tape created in 1996 was the basis of most of the studies performed over the past year. The device was compared with more traditional surgical techniques as well as new techniques such as the trans-obturator tape. In addition the tension-free vaginal tape was examined in women with pelvic organ prolapse and older in age. The complications of the device are well known and several studies recounted these with an attempt to predict patients who will have success. Modifications to surgical technique are described to improve patient results as well as further analysis of outcomes with post-surgical urodynamic-based studies. SUMMARY The majority of papers center on the tension-free vaginal tape and comparing other methods of incontinence surgery with the tape's success. With 7-year data, the device has secured its place in the treatment of female stress incontinence. Newer methods are being explored and are now compared with the tension-free vaginal tape's outcomes.
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Affiliation(s)
- Neil T Dwyer
- Department of Urology, University of Iowa, Iowa City, Iowa 52242-1089, USA
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Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000172405.15632.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bafghi A, Valerio L, Trastour C, Benizri E, Bongain A. [Evaluation of the TVT technique according to age]. ACTA ACUST UNITED AC 2005; 34:47-52. [PMID: 15767917 DOI: 10.1016/s0368-2315(05)82670-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To compare efficacy and long-term morbidity of the TVT between patients younger than 70 years and patients older than 70 years. METHOD Retrospective monocentric study from January 2000 to May 2001. A postal questionnaire was sent to patients to evaluate their satisfaction and their functional status after surgery. RESULTS The study included 154 patients, and 137 (89%) answered the questionnaire. Seventy-two were less than 70 years old (52.5%) and 65 were more than 70 years old (47.5%). The satisfaction rate in the total population was 88.3%. Amongst the patients younger than 70 years, 97.5% were cured or improved, versus 78.5% of the oldest patients (p=0.001). The study within age groups showed that the satisfaction rate between 70-74 years was higher (92.6%) than in the total population and lower after 75 years (66.7%). This difference is linked to the rates of de novo and persistent urge incontinence, which increase after 75 years. CONCLUSION The TVT seems to be a good treatment for urinary incontinence in women younger than 75 years. Patients should be warned that preoperative urge incontinence may persist after surgery.
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Affiliation(s)
- A Bafghi
- Service de Gynécologie-Obstétrique-Reproduction et de Médecine Foetale, Hôpital Archet 2, Nice
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