title: TVT-O for the treatment of pure urodynamic stress incontinence: efficacy, adverse effects, and prognostic factors at 5-year follow-up.
abstract: BACKGROUND
  Inside-out tension-free vaginal transobturator tape (TVT-O) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI), but data reporting long-term outcomes are scarce.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of TVT-O 5-yr implantation for management of pure SUI in women.
  
  
  METHODS
  A prospective observational study was conducted in four tertiary reference centers. Consecutive women presenting with urodynamically proven, pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded.
  
  
  METHODS
  TVT-O implantation without any associated procedure.
  
  
  METHODS
  Data regarding subjective outcomes (International Consultation on Incontinence-Short Form [ICIQ-SF], Patient Global Impression of Improvement, patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Multivariable analyses were performed to investigate outcomes.
  
  
  CONCLUSIONS
  Of the 191 women included, 21 (11.0%) had previously undergone a failed anti-incontinence surgical procedure. Six (3.1%) patients were lost to follow-up. The 5-yr subjective and objective cure rates were 90.3% and 90.8%, respectively. De novo overactive bladder (OAB) was reported by 24.3% of patients at 5-yr follow-up. Median ICIQ-SF score significantly improved from 17 (interquartile range [IQR]:16-17) preoperatively to 0 (IQR: 0-2) (p<0.0001). Failure of a previous anti-incontinence procedure was the only independent predictor of subjective recurrence of SUI (hazard ratio [HR]: 4.4; p = 0.009) or objective (HR: 3.7; p = 0.02). No predictive factor of de novo OAB was identified.
  
  
  CONCLUSIONS
  TVT-O implantation is a highly effective option for the treatment of women with pure SUI, showing a very high cure rate and a low incidence of complications after 5-yr follow-up.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy. mauserati@hotmail.com
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Ricarda
authors.initials: R
authors.lastname: Bauer
authors.forename: Jean Nicolas
authors.initials: JN
authors.lastname: Cornu
authors.forename: Elena
authors.initials: E
authors.lastname: Cattoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Braga
authors.forename: Gabriele
authors.initials: G
authors.lastname: Siesto
authors.forename: Daphné
authors.initials: D
authors.lastname: Lizée
authors.forename: François
authors.initials: F
authors.lastname: Haab
authors.forename: Marco
authors.initials: M
authors.lastname: Torella
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvatore
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D020127:Recovery of Function; D012008:Recurrence; D012307:Risk Factors; D053825:Suburethral Slings; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*