title: Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence--a long-term follow-up.
abstract: BACKGROUND
  To determine risk factors for the appearance of de novo urgency symptoms, and subsequent accompanying problems, after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence.
  
  
  METHODS
  A structured preoperative analysis of the incontinence symptoms was made. A mailed questionnaire was distributed to 970 women that underwent the TVT procedure between 1995 and 2001. Average follow-up was 5.2 years (range 2-8 years). The questionnaire included specific questions on current urinary symptoms and incontinence. The disease-specific quality of life instruments IIQ-7 and UDI-6 were used to compare women with, and those without de novo urgency.
  
  
  RESULTS
  Seven hundred and sixty women (78.3%) responded and 463 of those were identified as genuine stress incontinence preoperatively. De novo urgency occurred in 67 (14.5%) of the women. The frequency was similar irrespective of duration since the TVT procedure. The women that reported de novo urgency symptoms were compared with those without symptoms. Risk factors for occurrence of de novo urgency symptoms were older age (64.7 years versus 60.9 years; p=0.01), parity (2.6 versus 2.3; p=0.05), history of cesarean section (9.5% versus 2.5%; odds ratio 5.4), and history of recurrent urinary infections (29.7% versus 18.8%; odds ratio 1.6, but non-significant. De novo urgency had a severe impact on quality of life, as compared to the remaining study population.
  
  
  CONCLUSIONS
  Old age, parity and history of cesarean section were risk factors for de novo urgency after TVT surgery. Postoperative de novo urgency symptoms are as bothersome for the patient as the preoperative stress urinary incontinence.
authors.affiliation: Department of Obstetrics and Gynecology, Falun Hospital, 79182 Falun, Sweden. corinne.holmgren@ltdalarna.se
authors.forename: Corinne
authors.initials: C
authors.lastname: Holmgren
authors.forename: Staffan
authors.initials: S
authors.lastname: Nilsson
authors.forename: Lars
authors.initials: L
authors.lastname: Lanner
authors.forename: Dan
authors.initials: D
authors.lastname: Hellberg
mesh_terms: D000367:Age Factors; D000368:Aged; D002585:Cesarean Section; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010298:Parity; D011247:Pregnancy; D012307:Risk Factors; D053825:Suburethral Slings / Q000009:adverse effects*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000209:etiology*