title: Tension-free vaginal tape for the treatment of urodynamic stress incontinence with intrinsic sphincteric deficiency.
abstract: The purpose of this study was to evaluate the outcome of tension-free vaginal tape (TVT) procedure in women with urodynamic stress incontinence diagnosed as having intrinsic sphincteric deficiency (ISD). The combination of a maximal urethral closure pressure < 20 cm H2O and a Valsalva leak point pressure < 60 cm H2O was considered as diagnostic of ISD. Subjects with detrusor overactivity on preoperative urodynamics were excluded. A total of 35 patients with both low closure pressure and leak point pressure were enrolled. Bladder perforation occurred in three (8.6%) cases. Postoperative urinary voiding difficulties occurred in nine (25.7%) women. Two patients underwent surgical detension of the tape, with complete resolution of urinary retention and no relapse of incontinence. Women with postoperative voiding dysfunction had a significantly lower detrusorial pressure at the peak flow on preoperative urodynamics compared to those who voided efficiently after TVT. The mean (range) follow-up time was 12.5 months (3-36). The objective cure rate for stress incontinence was 91.4%. Two of the three (66%) patients in whom the TVT procedure failed had a fixed urethra. De novo urge incontinence was found in five (14.3%) patients.
authors.affiliation: Urogynecologic Unit, Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. fabio.ghezzi@uninsubria.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvatore
authors.forename: Paola
authors.initials: P
authors.lastname: Triacca
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Bolis
mesh_terms: D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011312:Pressure; D013526:Surgical Mesh / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics; D014621:Vagina / Q000601:surgery*