The efficacy of the tension-free vaginal tape in the treatment of five subtypes of stress urinary incontinence.
OBJECTIVE
To determine the efficacy of tension-free vaginal tape (TVT) for the treatment of five sub-types of stress urinary incontinence (SUI).


METHODS
A retrospective review was performed from November 1998 to November 2001 on all patients with SUI who underwent a TVT procedure either alone or with other reconstructive pelvic procedures. The patients were subdivided into five categories. Intrinsic sphincter deficiency (ISD) was defined by a maximum urethral closure pressure < 20 cm H2O or a mean Valsalva leak point pressure < 60 cm H2O above baseline. Urethral hypermobility (UH) was defined by a straining Q-tip angle greater than 30 degrees from the horizontal. Cure was defined as the subjective resolution of SUI without the development of voiding dysfunction or de novo urge incontinence. Improvement was defined as the subjective improvement of SUI without complete resolution or the subjective resolution of SUI occurring with the development of prolonged voiding dysfunction lasting greater than 6 weeks or de novo urge incontinence. Failure was defined as the subjective lack of improvement of SUI, the need for an additional procedure to correct SUI or the need for revision or takedown of the TVT for persistent voiding dysfunction or mesh erosion.


RESULTS
The cure, improvement and failure rates for each of the following groups are respectively as follows: group 1 (+UH, -ISD) (n = 121): 101 (83.5%), 13 (10.7%), 7 (5.8%); group 2 (-UH, +ISD) (n = 22): 17 (77.3%), 3 (13.6%), 2 (9.1%); group 3 (+UH, +ISD) (n = 32): 26 (81.3%), 4 (12.5%), 2 (6.2%); group 4 (-UH, -ISD) (n = 25): 21 (84.0%), 3 (12.0%), 1 (4.0%); group 5 (occult SUI) (n = 67): 57 (85.1%), 10 (14.9%), 0 (0%).


CONCLUSIONS
This study shows that the TVT is effective in treating all five sub-types of SUI.
Segal
Jeffrey L
JL
St. Barnabas Medical Center, Center for Urogynecology, Livingston, NJ, 07039, USA. jsegal@sbhcs.com
Vassallo
Brett J
BJ
Kleeman
Steven D
SD
Hungler
Melanie
M
Karram
Mickey M
MM
D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013526:Surgical Mesh; D016896:Treatment Outcome; D014521:Urethra / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*