Efficacy, safety and hospital costs of tension-free vaginal tape and pubovaginal sling in the surgical treatment of stress incontinence.
OBJECTIVE
The efficacy, safety and hospital costs of the tension-free vaginal tape procedure were compared with the pubovaginal sling operation.


METHODS
A total of 60 women urodynamically diagnosed as having stress or mixed urinary incontinence were operated on using either the tension-free vaginal tape or pubovaginal sling operation in a prospective manner. Preoperative characteristics of the women were not significantly different for the groups. The women were followed for up to 24 months.


RESULTS
In the tension-free vaginal tape group, the operation time was shorter, numbers of analgesics postoperatively required were less and hospital charges were less expensive compared to those in the pubovaginal sling operation (P < 0.01). Kaplan-Meier survival analysis showed a marginal significant difference (P = 0.059) in the objective cumulative cure rates at 24 months between the groups receiving the former (70.3%) and latter (48.3%) procedures. Subjective cure rates were not significantly different (P = 0.101). In both groups, an improvement in quality of life was significant and surgical complications were identical. De novo urge incontinence developed in 6% and 10% in the former and latter, respectively.


CONCLUSIONS
The tension-free tape was significantly superior to the pubovaginal sling in terms of operation time, postoperative pain, and hospital charges, but not in cure rates. A longer follow up with a larger sample size is necessary to draw definite conclusions.
Kondo
Atsuo
A
Department of Urology, Komaki Shimin Hospital, Komaki, Japan. akondo@fj8.so-net.ne.jp
Isobe
Yasuaki
Y
Kimura
Kyousuke
K
Kamihira
Osamu
O
Matsuura
Osamu
O
Gotoh
Momokazu
M
Ozawa
Hideo
H
D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000534:rehabilitation; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention; D013526:Surgical Mesh / Q000009:adverse effects / Q000191:economics; D016019:Survival Analysis; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods* / Q000534:rehabilitation