title: Efficacy analysis of trans-obturator tension-free vaginal tape (TVT-O) plus modified Ingelman-Sundberg procedure versus TVT-O alone in the treatment of mixed urinary incontinence: a randomized study.
abstract: OBJECTIVE
  The treatment of women with mixed urinary incontinence still poses a great challenge. This study evaluated surgical outcomes of combined trans-obturator tension-free vaginal tape (TVT-O) and modified Ingelman-Sundberg (IS) procedure for the treatment of mixed urinary incontinence.
  
  
  METHODS
  A randomized controlled trial was conducted. Ninety-six women diagnosed with mixed incontinence were randomized, with 49 allocated to TVT-O plus IS and 47 to TVT-O alone. A baseline urodynamic study and evaluation of quality of life (QOL) was conducted. The primary outcome measure was objective assessment of surgical outcomes, and the secondary outcome measure was warning time.
  
  
  RESULTS
  Objective surgical response rate was significantly higher in the TVT-O plus IS group than in the TVT-O alone group (84.8% vs. 62.8%; p=0.019). Furthermore, a significant increase in warning time was observed in the TVT-O plus IS group (from 3.9 to 9.4 min; p=0.006), but the increase in warning time within the TVT-O alone group was not statistically significant (from 4.3 to 4.5 min; p=0.695). Postoperative complications were similar in the two study groups with respect to pelvic hematoma, nerve injury, sepsis, mesh erosion, and fistula formation. However, fever occurred more frequently in the TVT-O plus IS group (30.4% vs. 20.9%; p=0.026).
  
  
  CONCLUSIONS
  Mixed urinary incontinence can potentially be treated with a one-step combined surgery using trans-obturator sling plus modified IS procedure. Although surgical time and blood loss were significantly increased in the TVT-O plus IS group, overall morbidity was not significantly increased.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, and Department of Epidemiology, Institute of Public Health, National Yang-Ming University, Taipei, Taiwan. cmjuang@yahoo.com.tw
authors.forename: Chi-Mou
authors.initials: CM
authors.lastname: Juang
authors.forename: Ken-Jen
authors.initials: KJ
authors.lastname: Yu
authors.forename: Pesus
authors.initials: P
authors.lastname: Chou
authors.forename: Ming-Shien
authors.initials: MS
authors.lastname: Yen
authors.forename: Nae-Fong
authors.initials: NF
authors.lastname: Twu
authors.forename: Huann-Cheng
authors.initials: HC
authors.lastname: Horng
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Hsu
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*