title: Seven years of objective and subjective outcomes of transobturator (TVT-O) vaginal tape: why do tapes fail?
abstract: OBJECTIVE
  This study reports long-term outcomes of the transvaginal tension-free vaginal tape-obturator (TVT-O) procedure for treating stress urinary incontinence (SUI), including possible risk factors for failure.
  
  
  METHODS
  This was a retrospective study of women who underwent TVT-O with or without concomitant prolapse surgery. Procedures were performed at a tertiary referral urogynecology unit. Participants presented with SUI and had urodynamic stress incontinence (USI). Women with a history of previous anti-incontinence procedures, radical pelvic surgery, and detrusor overactivity (DO) were excluded. Objective cure was defined as absence of urine leakage during a cough stress test (CST). Subjective outcome was based on the International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Quality of life was assessed using the King's Health Questionnaire (KHQ). Univariate and multivariate analyses were used to identify risk factors for subjective failure.
  
  
  RESULTS
  One hundred twenty-four consecutive women were assessed, with a median follow-up of 90.3 (range 80-103) months. Overall objective and subjective cure rates were 81.5 % (101/124) and 83.5 % (103/124), respectively. A significant improvement was observed in all KHQ domains. Concomitant vaginal hysterectomy [odds ratio (OR) = 2.98, 95 % confidence interval (CI) 1.10-8.05, p = 0.03] and increasing point C (OR = 1.17, 95 % CI 1.05-1.30, p = 0.006] were associated with a higher risk for subjective failure. De novo urgency rate was 7 %.
  
  
  CONCLUSIONS
  The TVT-O procedure provides high objective and subjective long-term efficacy, a clinically meaningful improvement in patient quality of life, and an excellent safety profile. Concomitant vaginal hysterectomy and apical compartment prolapse were associated with a higher risk for objective and subjective failure.
authors.affiliation: First Department of Obstetrics and Gynecology, Urogynecology Unit, National & Kapodistrian University of Athens, "Alexandra" Hospital, 80 Vas. Sofias Avenue, 11528, Athens, Greece, stavros.athanasiou@gmail.com.
authors.forename: Stavros
authors.initials: S
authors.lastname: Athanasiou
authors.forename: Themos
authors.initials: T
authors.lastname: Grigoriadis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Zacharakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Skampardonis
authors.forename: Dionysia
authors.initials: D
authors.lastname: Lourantou
authors.forename: Aris
authors.initials: A
authors.lastname: Antsaklis
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011788:Quality of Life / Q000523:psychology*; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000523:psychology* / Q000601:surgery*
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