Advertisement

International Urogynecology Journal

, Volume 15, Issue 3, pp 188–193 | Cite as

Are there any factors predicting the cure and complication rates of tension-free vaginal tape?

  • Bülent Çetinel
  • Oktay Demirkesen
  • Bulent Onal
  • Emre Akkus
  • Cabir Alan
  • Gunay Can
Original Article

Abstract

Predictive factors that could possibly affect the cure and complication rates of tension-free vaginal tape (TVT) in the treatment of stress urinary incontinence (SUI) were investigated. Seventy-five consecutive patients with urodynamically proven SUI and who had undergone a TVT operation were evaluated according to a follow-up protocol. Median age was 51.2 (33–69). Thirteen (17%) of the patients had had previous anti-incontinence surgery. Sixteen (21%) patients had complained of pure stress and 59 (79%) of mixed incontinence. Valsalva leak point pressure (VLPP) values had been found to be below 60 cmH2O in 36 (48%) and over 60 cmH2O in 39 (52%) patients, while detrusor overactivity (DO) had been detected in six (8%) patients during urodynamic evaluation. Local, general, and epidural anesthesia had been performed in 43 (57%), 29 (39%), and three (4%) patients, respectively. Univariate analyses were done using Fisher’s exact and Chi-square tests. Multivariate analyses were done using logistic regression test to determine predictive factors affecting cure and complication rates. Mean surgical and hospitalization times were 34.7 min (20–70) and 1.2 days (1–5), respectively. Mean follow-up was 21.6 months (6–38). Cure and improvement rates were 89 and 8%, respectively. Thirty-one complications were observed in 27 (36%) patients. Intraoperative bladder perforation and bleeding occurred in three (4%) and two (3%) patients, respectively. Sixty-six (88%) patients voided spontaneously after TVT while nine (12%) performed clean intermittent catheterization (CIC) for a period of time. Seven of nine patients regained the spontaneous voiding ability within 1 month. The tape was cut in two of these retentive patients and one with severe storage lower urinary tract symptoms (LUTS) either unilaterally or bilaterally. On univariate (Fisher’s exact test, p =0.018), and multivariate (Logistic regression, p =0.013) analyses, patient age was the only statistically significant parameter affecting the cure rate, which was significantly lower particularly over 55 years of age. No significant factor predicting the complications was detected. TVT is an effective and safe surgical procedure in the treatment of SUI. In this study age was the only significant predictive factor affecting the cure rate while no significant factor predicting the complications was detected. Cure rate was significantly lower in patients over 55 years of age.

Keywords

Stress urinary incontinence Tension-free vaginal tape 

References

  1. 1.
    Brocklehurst JC (1993) Urinary incontinence in the community-analysis of a MORI poll. BMJ 306:832–834PubMedGoogle Scholar
  2. 2.
    Thomas MT, Plymat KR, Blannin J, et al (1980) Prevelance of urinary incontinence. BMJ 281:1243–1245PubMedGoogle Scholar
  3. 3.
    Keane DP, Eckford SD, Shepherd AM, Abrams P (1992) Referral patterns and diagnoses in women attending a urodynamic unit. BMJ 305:808Google Scholar
  4. 4.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al. (2002) The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodynamics 21:167–178CrossRefGoogle Scholar
  5. 5.
    De Lancey JOL, Fowler CJ, Keane D, et al (1999) Pathophysiology. In: Abrams P, Khoury S, Wein AJ (eds) Incontinence. Health Publication, Plymouth, UK, pp 227Google Scholar
  6. 6.
    Ulmsten U, Petros P (1995) Intravaginal slingplasty (IVS): an ambulatory surgical procedure for treatment of female urinary incontinence. Scand J Urol Nephrol 29:75–82PubMedGoogle Scholar
  7. 7.
    Ulmsten U, Johnson P, Rezapour M (1999) A three year follow up of tension-free vaginal tape for surgical treatment of female stress urinary incontinence. Br J Obstet Gynaecol 106:345–350PubMedGoogle Scholar
  8. 8.
    Olsson I, Kroon U (1999) A three-year postoperative evaluation of tension-free vaginal tape. Gynecol Obstet Invest 48:267–269PubMedGoogle Scholar
  9. 9.
    Abrams P, Blaivas JG, Stanton SL, et al (1988) The standardisation of terminology of lower urinary tract function. The International Continence Society Committee on Standardisation of Terminology. Scand J Urol Nephrol 114[Suppl]: 5–19Google Scholar
  10. 10.
    Nilsson CG, Kuuva N, Falconer C, Rezapour M, Ulmsten U (2001) Long-term results of the tension-free vaginal tape (TVT) procedure for surgical treatment of female stress urinary incontinence. Int Urogynecol J 12[Suppl 2]: S5–S8Google Scholar
  11. 11.
    Deval B, Jeffry L, Najjar FA, Soriano D, Darai E (2002) Determinants of patient dissatisfaction after a tension-free vaginal tape procedure for urinary incontinence. J Urol 167:2093–2097CrossRefPubMedGoogle Scholar
  12. 12.
    Wang AC, Chen MC (2001) Randomized comparison of local versus epidural anesthesia for tension-free vaginal tape operation. J Urol 165:1177–1180PubMedGoogle Scholar
  13. 13.
    Rezapour M, Ulmsten U (2001) Tension-free vaginal tape (TVT) in women with recurrent stress urinary incontinence: a long-term follow up. Int Urogynecol J 12[Suppl 2]): S9–S11Google Scholar
  14. 14.
    Rezapour M, Falconer C, Ulmsten U (2001) Tension-free vaginal tape (TVT) in stress incontinent women with inrtrinsic sphincter deficiency (ISD): a long-term follow up. Int Urogynecol J 12[Suppl 2]: S12–S14Google Scholar
  15. 15.
    Rezapour M, Ulmsten U (2001) Tension-free vaginal tape (TVT) in women with mixed urinary incontinence: a long-term follow up. Int Urogynecol J 12[Suppl 2]: S15–S18Google Scholar
  16. 16.
    Lo TS, Huang HJ, Chang CL, Wong SY, Horng SG, Liang CC (2002) Use of intravenous anesthesia for tension-free vaginal tape therapy in elderly women with genuine stress incontinence. Urology 59:349–353CrossRefPubMedGoogle Scholar
  17. 17.
    Lebret T, Lugagne PM, Herve JM, Barre P, Orsoni JL, Yonneau L, Saporta F, Botto H (2001) Evaluation of tension-free vaginal tape procedure. Eur Urol 40:543–547CrossRefPubMedGoogle Scholar
  18. 18.
    Haab F, Sananes S, Amarenco G, Ciofu C, Uzan S, Gattegno B, Thibault P (2001) Results of the tension-free vaginal tape procedure for the treatment of type II stress urinary incontinence at a minimum followup of 1 year. J Urol 165:159–162PubMedGoogle Scholar
  19. 19.
    Kuuva N, Nilsson CG (2002) A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstet Gynecol Scand 81:72–77Google Scholar
  20. 20.
    Meschia M, Pifarotti P, Bernasconi F, Guercio E, Maffiolini M, Magatti F, Spreafico L (2001) Tension-free vaginal tape: analysis of outcomes and complications in 404 stress incontinent women. Int Urogynecol J 12[Suppl 2]: S24–S27Google Scholar
  21. 21.
    Levine S, Rosen Y, Sluvis A, Benet A, Levine D (2002) Is cystoscopy reliable in detecting iatrogenic bladder perforation during the tension-free vaginal tape procedure. Int Urogynecol J 13[Suppl 1]: S14Google Scholar
  22. 22.
    Klutke C, Siegel S, Carlin B, Paskiewicz E, Kirkemo A, Klutke J (2001) Urinary retention after tension-free vaginal tape procedure: incidence and treatment. Urology 58:697–701CrossRefPubMedGoogle Scholar
  23. 23.
    Moran PA, Ward KL, Johnson D, Smirni WE, Hilton P, Bibby J (2000) Tension-free vaginal tape for primary genuine stress incontinence: a two-centre follow-up study. Br J Urol 86:39–42CrossRefGoogle Scholar
  24. 24.
    Sweat SD, Itano NB, Clemens JQ, Bushman W, Gruenenfelder J, McGuire EJ, Lightner DJ (2002) Polypropylene mesh tape for stress urinary incontinence: complications of urethral erosion and outlet obstruction. J Urol 168:144–146PubMedGoogle Scholar
  25. 25.
    Comiter VC, Vasavada SP, Kavaler E, Carbone JM, Raz S (2000) The surgical treatment of female SUI: making an intelligent choice. Contemporary Urol 12:62Google Scholar

Copyright information

© International Urogynecological Association 2004

Authors and Affiliations

  • Bülent Çetinel
    • 1
  • Oktay Demirkesen
    • 1
  • Bulent Onal
    • 1
  • Emre Akkus
    • 1
  • Cabir Alan
    • 1
  • Gunay Can
    • 2
  1. 1.Department of Urology, Cerrahpasa School of MedicineIstanbul UniversityIstanbulTurkey
  2. 2.Department of Public Health, Cerrahpasa School of MedicineIstanbul UniversityIstanbulTurkey

Personalised recommendations