title: Long-term durability, functional outcomes, and factors associated with surgical failure of tension-free vaginal tape procedure.
abstract: OBJECTIVE
  The cure rate of tension-free vaginal tape (TVT) appeared to decrease overtime, with an associated increased in the stress urinary incontinence (SUI) recurrence rate. We evaluated the long-term durability and functional outcomes of TVT and identified the risk factors that may affect recurrence.
  
  
  METHODS
  Eighty-eight patients, who were cured of SUI 6 months after undergoing TVT, were followed-up for at least 12 years. At post-operative, the patients were evaluated with a Severity Index for Urinary Incontinence questions regarding cure, patient's satisfaction, goal achievement, 3-day voiding diary with urinary urgency scale, uroflowmetry, and complications.
  
  
  RESULTS
  Cure rates decreased from 96.6 % at 1-year post-surgery to 83.0 % at 5 years and that the cure rates between 5 and 12 year were similar (83.0 vs. 79.6 %). Valsalva leak point pressure (VLPP) < 60 H(2)O was the only independent factor that predicted recurrence (p = 0.011; hazard radio 5.31). At last follow-up, 39.2 and 70.0 % of patients were free of urgency and urgency incontinence, respectively; and de novo urgency and urgency incontinence developed in 40.5 and 17.2 % of these patients, respectively. Age was the only factor that predicted freedom from overactive bladder (OAB) symptom. There was a significant reduction in the maximal flow rate from 23.3 ± 9.0 ml/s pre-operation to 18.8 ± 6.7 ml/s at 12 years post-operation.
  
  
  CONCLUSIONS
  TVT is an effective long-term treatment for SUI, although the cure rate may decrease with time. A low VLPP was predictive of SUI recurrence, and patients showing no OAB symptoms tended to be younger.
authors.affiliation: Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Ji-Yeon
authors.initials: JY
authors.lastname: Han
authors.forename: Junsoo
authors.initials: J
authors.lastname: Park
authors.forename: Myung-Soo
authors.initials: MS
authors.lastname: Choo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D013536:Suture Techniques; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014563:Urodynamics