title: Tension-free vaginal tape-obturator in the treatment of stress urinary incontinence: a prospective study with five-year follow-up.
abstract: OBJECTIVE
  To evaluate the medium-term outcomes of using tension-free vaginal tape-obturator (TVT-O) in the treatment of patients with stress urinary incontinence (SUI).
  
  
  METHODS
  Between December 2004 and November 2005, 103 patients with SUI were enroled and treated with TVT-O with inside-out modification. A minimum five-year follow-up (median, 65 months) was obtained from 100 patients (99.6%). Preoperative and postoperative evaluations were performed for all patients. The objective success rate of the TVT-O procedure was evaluated by a negative stress test. The secondary outcomes measured included one- and five-year subjective success rates, together with the pre- and post-operative urodynamic parameters, complications, quality of life (QOL) analysis, and patient satisfaction.
  
  
  RESULTS
  Among the 103 patients, 18 (17.4%) had postoperative voiding difficulties and needed urethral bladder catheterization for various periods. After the TVT-O procedure, complete disappearance of SUI occurred in 87.4% of patients, while improvement was found in about 92%. In addition, there was no difference in the cure rate between year 1 and year 5 after the procedure (P>0.05). In 90 patients, frequency and urge symptoms were significantly improved five years after the procedure (P<0.005), and maximal flow rates were decreased (P<0.05). However, the severity of obstructive symptoms and postvoid residual volumes at five years were not improved compared with one year after the procedure (P=0.10 and P=0.33 respectively). Finally, compared to pre-operation, incontinence severity degree and QOL scale scores were largely improved after the operation (P<0.001), while no difference was found between years 1 and 5 (P=0.11and P=0.09 respectively).
  
  
  CONCLUSIONS
  Our result shows that the TVT-obturator, a novel mid-urethral sling, is a safe and effective procedure for the treatment of female SUI. Medium-term therapeutic results appear promising but further evaluation of long-term therapeutic outcomes is needed.
authors.affiliation: Department of Gynecology and Obstetrics, Shengjing Hospital, China Medical University, Shenyang, China. chengdalishengjing@163.com
authors.forename: Dali
authors.initials: D
authors.lastname: Cheng
authors.forename: Caigang
authors.initials: C
authors.lastname: Liu
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006119:Groin; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D011788:Quality of Life; D012086:Reoperation; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D053825:Suburethral Slings / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000503:physiopathology; D014563:Urodynamics