Tension-Free vaginal tape (TVT) in stress incontinent women with intrinsic sphincter deficiency (ISD)--a long-term follow-up.
In a prospective long-term study 49 women with stress incontinence and ISD (intrinsic sphincter deficiency) were followed for a mean of 4 years (range 3-5) after TVT operation. Preoperatively all patients underwent urodynamic investigations, quality of life evaluation, a 24-hour pad test and a gynecologic examination to properly verify the incontinence symptoms. The same protocol was used for postoperative evaluation. The mean age of the women was 66 years (+/- 11) and mean parity 2 (range 0-4). A standard TVT operation was performed under local anesthesia. At the postoperative evaluations 36 patients (74%) were completely cured of their incontinence problems. In addition, 6 women (12%) were significantly improved. In 7 patients (14%) no improvement was found. The majority of these not cured patients were >70 years of age and had urethral resting pressure of <10 cmH2O. Few intra- and postoperative complications occurred. It is concluded that TVT can be used for surgical treatment of patients with ISD and stress incontinence. However, older patients (>70 years) with a very low resting urethral pressure and an immobile urethra seem to constitute a risk group where TVT surgery is less successful.
Rezapour
M
M
Department of Obstetrics and Gynecology, Uppsala University Hospital, Sweden. masoumeh.rezapour@kbh.uu.se
Falconer
C
C
Ulmsten
U
U
D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011446:Prospective Studies; D013997:Time Factors; D014522:Urethral Diseases / Q000150:complications*; D014550:Urinary Incontinence, Stress / Q000209:etiology* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014621:Vagina