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Solhaug BR, Nyhus MØ, Svenningsen R, Volløyhaug I. Rates of subjective and objective cure, satisfaction, and pain 10-20 years after tension-free vaginal tape (TVT) surgery: A retrospective cohort study. BJOG 2024; 131:1146-1153. [PMID: 38126201 DOI: 10.1111/1471-0528.17738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/23/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To evaluate rates of subjective and objective cure, treatment satisfaction, pain, and the correlation between cure and body mass index (BMI), at 10 and 20 years after tension-free vaginal tape (TVT) surgery. DESIGN Retrospective cohort study. SETTING Multicentre study including 19 units in Norway. POPULATION Women undergoing TVT surgery for stress urinary incontinence (SUI) during 2001-2006 (20-year cohort) and 2011-2012 (10-year cohort). METHODS The Norwegian Female Incontinence Registry was used to identify women eligible for the study, who answered validated questionnaires about urinary incontinence, pain and satisfaction. MAIN OUTCOME MEASURES Subjective cure of SUI (with stress index of <3, range 0-12), objective cure (<3 g on stress test) and persisting pain and satisfaction after TVT (scored on a five-point Likert scale). RESULTS In total, 1210 of 1903 (64%) patients responded. The subjective cure rate was 68% after 10 years, versus 59% after 20 years, and did not significantly differ after adjusting for age, BMI, parity and preoperative stress index (adjusted OR 1.27, 95% CI 0.82-1.94). The objective cure rate was 100% versus 93% (P < 0.001), with 89% versus 76% reporting subjective satisfaction (P < 0.001), and with 4.7% versus 2.7% reporting persisting pain (P < 0.001), after 10 versus 20 years, respectively. Women in obesity classes I and II, compared with women of normal weight, had an increased risk of not being subjectively cured (crude OR 2.02, 95% CI 1.42-2.90; OR 2.95, 95% CI 1.60-5.46, respectively). CONCLUSIONS Tension-free vaginal tape (TVT) provided high rates of subjective and objective cure at 10 and 20 years after surgery, with no significant difference between the two cohorts. Although 3%-5% of women experienced persisting pain, most women were satisfied with TVT surgery. Obesity was associated with a lower cure rate.
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Affiliation(s)
- Berit Rein Solhaug
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Maria Øyasæter Nyhus
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rune Svenningsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
- The Norwegian Female Incontinence Registry, Oslo University Hospital, Oslo, Norway
| | - Ingrid Volløyhaug
- Department of Obstetrics and Gynecology, St. Olavs University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Goessens EMV, Cammu H. A 10- to 20-year follow-up after tension-free vaginal tape for stress urinary incontinence. Int Urogynecol J 2023; 34:2107-2114. [PMID: 37000213 DOI: 10.1007/s00192-023-05510-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/17/2023] [Indexed: 04/01/2023]
Abstract
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.
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Affiliation(s)
- Emilie M V Goessens
- Department of Urology, ZNA Middelheim Antwerpen, Lindendreef 1, 2020, Antwerp, Belgium.
| | - Hendrik Cammu
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Manach Q, Bouquot M, Rouprêt M, Ambrogi V, Richard F, Bitker MO, Chartier-Kastler E, Phé V. [Placement of tension-free vaginal tape in women with stress urinary incontinence: Long-term functional outcomes in a prospective series]. Prog Urol 2017; 27:640-646. [PMID: 28651995 DOI: 10.1016/j.purol.2017.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/01/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the long-term functional outcomes after retropubic tension-free vaginal tape (TVT) placement to treat female stress urinary incontinence (SUI). METHODS From September 1998 to September 2000, we prospectively enrolled all consecutive women in our center suffering SUI caused by urethral hypermobility. All women had a retropubic TVT inserted by the same surgeon. Patients were evaluated at 1, 3, 6 and 12 months postoperatively, and annually thereafter. Postoperative assessment included a measurement of post-voiding residual volume, urinalysis, a 1-hour pad test, a urinary symptom questionnaire, and an assessment of quality-of-life. Objective continence (defined as no urine leakage at clinical examination) and subjective continence (defined as no urine leakage, whatever the mechanism, reported by the patient) were reported. RESULTS Overall, 58 consecutive women (median age 59; IQR 49-67; min 21-max 78) were evaluated. Median follow-up was 10.2years (IQR 1.4-16.0; min 1-max 13.2). At the last follow-up, objective and subjective continence rates were 93% and 78%, respectively and remained stable in the long run. Pad tests, urinary symptom questionnaire scores and quality-of-life were significantly improved. Self-intermittent catheterisation was required by three women. A section of one TVT and removal of another tape was undertaken in two women with chronic pelvic pain. One patient had a chronic urinary infection. Rate of de novo urgency was 10%. CONCLUSIONS TVT implantation offered good and stable functional long-term outcomes. This procedure enhanced quality-of-life and had low morbidity. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Q Manach
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M Bouquot
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M Rouprêt
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - V Ambrogi
- Service de santé publique, informatique médicale et biostatistique, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France.
| | - F Richard
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - M O Bitker
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - E Chartier-Kastler
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - V Phé
- Service d'urologie, hôpital universitaire Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, Sorbonne universités, université Paris 6, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Blaivas JG, Purohit RS, Benedon MS, Mekel G, Stern M, Billah M, Olugbade K, Bendavid R, Iakovlev V. Safety considerations for synthetic sling surgery. Nat Rev Urol 2015; 12:481-509. [DOI: 10.1038/nrurol.2015.183] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Ignjatovic I, Potic M, Basic D, Dinic L, Medojevic N, Laketic D, Skakic A, Mihajlovic M. Self-created transobturator tape treatment of stress urinary incontinence without prior urodynamic investigation. Eur J Obstet Gynecol Reprod Biol 2014; 182:76-80. [PMID: 25262290 DOI: 10.1016/j.ejogrb.2014.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/31/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate and compare the results of tension free self-created transobturator tape (SCTOT) with the standard industrially created transobturator tape (ICTOT) in the treatment of stress urinary incontinence (SUI). STUDY DESIGN A prospective study of the treatment of SUI with SCTOT (67 patients) and ICTOT (47 patients) was performed. SCTOT was created from polypropylene mesh and monofilament sutures. The symptoms were evaluated before and after the surgery with the following: the Incontinence Impact questionnaire (IIC-7), the urogenital distress inventory (UDI-6), and the International Continence impact questionnaire short form (ICIQ5-SF). The overactive bladder symptom score (OABSS) was used to classify patients in the SUI or the mixed urinary incontinence (MUI) group. The follow up period was 18 months. Cure was defined as a negative stress test and no need for additional surgery. RESULTS Objective cure was achieved in 56/67 (83.5%) participants in the SCTOT group and in 40/47 (85.1%) participants in the ICTOT group (p>0.05). There was a significant improvement in IIC-7, UDI-6, ICIQ5-SF and OABSS in both groups. Improvement was better in the group with pure SUI than in patients with MUI, but this difference was not significant. Postoperative infection occurred in 5/67 (7.4%) participants and in 5/47 (10.6%) patients in the SCTOT and the ICTOT group, respectively. De novo overactive bladder symptoms occurred in 4/67 (5.9%) of the participants in the SCTOT group and in 3/47 (6.3%) of the patients in the ICTOT group. Operating time was longer in patients with SCTOT compared to those with ICTOT. CONCLUSION The results of the treatment with SCTOT are not inferior to the results of the treatment with ICTOT and other results reported in the literature.
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Affiliation(s)
- Ivan Ignjatovic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia.
| | - Milan Potic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Dragoslav Basic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Ljubomir Dinic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Nina Medojevic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | | | - Aleksandar Skakic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Marija Mihajlovic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
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Campeau L. Urodynamics in stress incontinence: when are they necessary and how do we use them? Urol Clin North Am 2014; 41:393-8, viii. [PMID: 25063595 DOI: 10.1016/j.ucl.2014.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Stress urinary incontinence is a prevalent condition that significantly impairs the quality of life. This article presents a critical summary of the current literature on the use and value of urodynamic studies in the evaluation of stress urinary incontinence in women.
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Affiliation(s)
- Lysanne Campeau
- Division of Urology, Department of Surgery, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1E2, Canada.
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