title: The tension-free vaginal tape in women with a non-hypermobile urethra and low maximum urethral closure pressure.
abstract: The objective of this study was to estimate the cure rate and to identify risk factors that predict failure of the tension-free vaginal tape (TVT) in women with stress urinary incontinence (SUI), a non-hypermobile urethra, and low maximum urethral closure pressure. Thirty-six women with SUI, a non-hypermobile urethra (straining urethral angle<or=35 degrees), and low maximum urethral closure pressure (MUCP<or=25 cm H2O) underwent a TVT. Cure was defined as resolution of subjective SUI symptoms and a negative cough stress test, which were measured after 4, 12, 18, and 24 months. Patient characteristics were compared and receiver-operator curves were used to identify risk factors for failure. The mean age was 71 years, and mean follow-up was 20.9 months. The overall cure rate was 78%. Risk factors for failure of the TVT were a straining urethral angle<or=20 degrees (cure rate 50%, odds ratio 7.7, p=0.02) and a MUCP<or=15 cm H2O (cure rate 60%, odds ratio 6.3, p=0.03). For women with both risk factors, the cure rate was only 17% (p<0.001). No other risk factors were identified. The TVT has moderate success (50-60%) for women with SUI and one risk factor (a straining urethral angle<or=20 degrees or a MVCP<or=15 cm H2O), but has poor success (17%) when both risk factors are present.
authors.affiliation: Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Madigan Army Medical Center, Tacoma, WA 98431, USA. Jeffrey.Clemons@amedd.army.mil
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Clemons
authors.forename: Christine A
authors.initials: CA
authors.lastname: LaSala
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011312:Pressure; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D017211:Treatment Failure; D014521:Urethra / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014554:Urination / Q000502:physiology*