title: Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion.
abstract: OBJECTIVE
  Intrinsic sphincter deficiency (ISD) is a known risk factor for therapy failure after tension-free vaginal tape (TVT) insertion. The purpose of this study was to investigate if the severity of ISD alone or other factors such as urethral mobility and tape localization influence outcomes.
  
  
  METHODS
  One hundred and nine women with urodynamically determined ISD, a TVT insertion, and a 6-month follow-up visit were included. Urethral length, mobility, and tape localization were evaluated by pelvic floor sonography. Patients were classified into three urethral mobility groups (hypomobile, normomobile, hypermobile). Surgical outcome was assessed by a combination of objective and subjective criteria.
  
  
  RESULTS
  Therapeutic success rate after TVT insertion was 81.6%. The severity of ISD did not associate with therapy failure. But urethral mobility (P < 0.0001), relative tape position (P = 0.0003), and tape-urethra distance (P < 0.0001) differed between cured and not cured patient groups. Patients with a relative tape position toward 1/2 of urethral length had a higher cure rate. Significantly different cure rates (P = 0.0003) were found for hypomobile (67%), normomobile (76%), and hypermobile (100%) urethras. For ISD patients with a hypomobile urethra, highest cure rates were obtained for tape-urethra distances between 2.5 and 3.5 mm.
  
  
  CONCLUSIONS
  The reduced cure rate for ISD patients was due to the subgroup with a hypomobile urethra. A prospective study is needed to confirm that slightly shorter tape-urethra distances and a relative tape position more toward the mid-urethra will lead to better outcomes for this patient group.
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland.
authors.forename: Edyta
authors.initials: E
authors.lastname: Wlaźlak
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Volker
authors.initials: V
authors.lastname: Viereck
authors.affiliation: Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, Hagen, Germany.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kociszewski
authors.affiliation: Department of Gynecology and Obstetrics, Lutheran Hospital Hagen-Haspe, Hagen, Germany.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kuszka
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Rautenberg
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Walser
authors.affiliation: Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Surkont
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Gamper
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland.
authors.forename: Mathias K
authors.initials: MK
authors.lastname: Fehr
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009929:Organ Size; D011446:Prospective Studies; D012307:Risk Factors; D053825:Suburethral Slings; D016896:Treatment Outcome; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D014522:Urethral Diseases; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014563:Urodynamics
keywords: cure rate; midurethral sling; one-third rule; pelvic floor sonography; stress urinary incontinence; tension-free vaginal tape