title: Long-term outcome of transobturator tension-free vaginal tape: efficacy and risk factors for surgical failure.
abstract: OBJECTIVE
  To assess the 5-year efficacy of the inside-out transobturator tension-free vaginal tape (TVT-O) for the treatment of stress urinary incontinence (SUI) and to explore possible predictors for long-term failure.
  
  
  METHODS
  Sixty-five consecutive patients who underwent TVT-O were prospectively enrolled. Patients who required concomitant anterior or apical pelvic organ prolapse repair or both and those with urodynamic occult SUI were excluded. Postoperatively, patients were scheduled for evaluation at 1, 3, 6, and 12 months and annually thereafter. Surgical failure was defined as positive stress test, daily episodes of SUI, and negative global satisfaction. Preoperative and interim clinical and urodynamic predictors for long-term failure were analyzed from a computerized database.
  
  
  RESULTS
  Sixty-one patients (mean age at surgery 56.6±10.2 years) completed 5 years of follow-up. Of these, 11 (18%) patients were classified as surgical failure, 5 (8%) as improved, and 45 (74%) as cured. Any SUI (100% vs. 10%, p=0.001), daily SUI (100% vs. 0%, p=0.001), overactive bladder (OAB) (100% vs. 48%, p=0.001), and the use of antimuscarinic drugs (64% vs. 26%, p=0.03) were found to be significantly more common among failure cases. Preoperative detrusor overactivity (odds ratio [OR] 7.6, 95% confidence interval [CI] 1.7-32.9), interim 1-year OAB (OR 20.5, 95% CI 1.9-215.4), and interim 1-year SUI (OR 26.4, 95% CI 1.5-475.2) were found to be significant independent risk factors for long-term surgical failure.
  
  
  CONCLUSIONS
  An 18% rate of surgical failure was observed 5 years after TVT-O. Larger studies with longer follow-up periods may facilitate the identification of risk factors for failure and, thus, enable better preoperative consultation.
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv, Israel. agroutz@yahoo.com
authors.forename: Asnat
authors.initials: A
authors.lastname: Groutz
authors.forename: Gila
authors.initials: G
authors.lastname: Rosen
authors.forename: Ronen
authors.initials: R
authors.lastname: Gold
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Lessing
authors.forename: David
authors.initials: D
authors.lastname: Gordon
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007557:Israel; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D053825:Suburethral Slings / Q000592:standards*; D014550:Urinary Incontinence, Stress / Q000628:therapy