Tension-free vaginal tape in the elderly: is it a safe procedure?
OBJECTIVE
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.
Gordon
David
D
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.
Gold
Ronen
R
Pauzner
David
D
Lessing
Joseph B
JB
Groutz
Asnat
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D019736:Prostheses and Implants / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects