Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence

In a prospective long-term Nordic multicenter study, 90 consecutive patients who had a tension-free vaginal tape (TVT) operation performed because of stress urinary incontinence were evaluated according to a strict protocol after approximately 5 years (range 48-70 months). Eighty-five patients could be evaluated according to the protocol. Another 5 elderly patients had to be interviewed by telephone at the final check-up after 5 years. The study protocol involved pre- and postoperative objective and subjective evaluation. The median follow-up time was 56 months. Seventy-two of the 85 patients who were fully evaluated (84.7%) were both objectively and subjectively completely cured. Another 9 patients (10.6%) were significantly improved and 4 (4.7%) were regarded as failures. No patient complained of long-term voiding difficulties and there were no signs of defective healing or rejection of the tape material. All patients had suffered from primary stress incontinence, and 25 also had preoperative complaints of urge. In 14 of these (56%) the urge symptoms were relieved postoperatively. We conclude that the TVT procedure seems to fulfil the expectations of high long-term cure rates, as suggested in previous short-term reports.

The tension-free vaginal tape procedure is successful in the majority of women with indications for surgical treatment of urinary stress incontinence

OBJECTIVES

To evaluate the effectiveness and safety of the ambulatory, minimally invasive tension-free vaginal tape procedure in women scheduled for incontinence surgery.

DESIGN

A prospective open study with a standardised protocol for pre- and post-operative evaluation.

PARTICIPANTS

One hundred and sixty-one consecutive women with urodynamically proven stress incontinence. The mean age was 56 years; 45 women (28%) had recurrent incontinence, 59 women (37%) had mixed incontinence and 18 women (11%) had a low pressure urethra.

MAIN OUTCOME MEASURES

Subjective and objective cure rates, complications and length of hospital stay.

RESULTS

The average follow up time was 16 months. Ninety-four percent of the treated women were completely cured or significantly improved. Eighty percent of the women were released from hospital on the afternoon of the day of surgery. There were no major complications and 80.2% of the women had no complication at all. Seven women (4.3%) had no more than four days of urinary retention problems, five women (3.1%) developed de novo urge symptoms, ten women (6.1%) had urinary tract infection, six cases (3.7%) of intraoperative bladder perforation occurred and less than 3% had bleeding or infection problems. There was no difference in the cure rate between women suffering from primary, recurrent or mixed incontinence.

CONCLUSIONS

The tension-free vaginal tape operation is an effective and safe procedure for treatment of most cases of female urinary stress incontinence. The operation can be performed as an ambulatory procedure because of the low risk of post-operative morbidity.