title: Tension-free vaginal tape (TVT) for the treatment of occult stress urinary incontinence in women undergoing prolapse repair: a prospective study of 100 consecutive cases.
abstract: OBJECTIVE
  Clinically continent women with genitourinary prolapse and occult stress urinary incontinence (SUI) are considered to be at high risk of developing symptomatic SUI once the prolapse is repaired. We studied the efficacy and safety of tension-free vaginal tape (TVT) procedure in preventing postoperative SUI in these women.
  
  
  METHODS
  One hundred consecutive women (mean age 66.7 +/- 9.9 years) with significant genitourinary prolapse and occult SUI were prospectively enrolled. Preoperatively, none of the women complained of SUI. However, all had urodynamically-confirmed occult SUI, revealed by repositioning of the prolapse. Surgical intervention was comprised of transvaginal prolapse repair and prophylactic TVT procedure. Main outcome end points included operative morbidity, postoperative SUI, persistent or de novo urge incontinence, and voiding dysfunction.
  
  
  RESULTS
  The mean follow-up period was 27 months (range: 12-52 months). There was only one case of technique-related bladder perforation with no adverse outcome. Two other patients had postoperative urinary retention necessitating catheterization for more than 7 days, none of whom required any surgical intervention. Vaginal erosion of the tape was diagnosed in three patients, all of whom were successfully treated by excision of the eroded tape. Two (2%) patients developed urodynamically-confirmed SUI within 1 year postoperatively. However, postoperative urodynamics revealed asymptomatic sphincteric incontinence in 15 (15%) other patients. Thirteen (72%) of 18 patients with preoperative urge incontinence had postoperative persistent urge incontinence. De novo urge incontinence developed postoperatively in 8 (8%) patients.
  
  
  CONCLUSIONS
  TVT procedure is effective and safe in patients with occult SUI undergoing prolapse repair. Long-term durability of this procedure is yet to be established.
authors.affiliation: Department of Obstetrics and Gynecology, Urogynecology and Pelvic Floor Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. agroutz@yahoo.com
authors.forename: Asnat
authors.initials: A
authors.lastname: Groutz
authors.forename: Ronen
authors.initials: R
authors.lastname: Gold
authors.forename: David
authors.initials: D
authors.lastname: Pauzner
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Lessing
authors.forename: David
authors.initials: D
authors.lastname: Gordon
mesh_terms: D000368:Aged; D001458:Bandages; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D001745:Urinary Bladder Diseases / Q000150:complications; D014550:Urinary Incontinence, Stress / Q000517:prevention & control*; D014563:Urodynamics; D014596:Uterine Prolapse / Q000175:diagnosis / Q000601:surgery*