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Seven years of objective and subjective outcomes of transobturator (TVT-O) vaginal tape: Why do tapes fail?

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Abstract

Introduction and hypothesis

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.

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Abbreviations

SUI:

Stress urinary incontinence

MUS:

Midurethral slings

USI:

Urodynamic stress incontinence

UDS:

Urodynamics

DO:

Detrusor overactivity

ICIQ-FLUTS:

International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms

KHQ:

King’s Health Questionnaire

POP-Q:

Pelvic Organ Prolapse Quantification

PFR:

Anterior and posterior pelvic floor repairs

VH:

Vaginal hysterectomy

SCP:

Laparoscopic sacrocolpopexy

POP:

Pelvic organ prolapse

CST:

Cough stress test

MICD:

Minimal important clinical difference

OAB:

Overactive bladder

USL:

Uterosacral ligament

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Conflict of interest

Stavros Athanasiou has received travel expenses from Johnson & Johnson.

Themos Grigoriadis has received travel expenses from Johnson & Johnson.

Dimitrios Zacharakis: None

Nikolaos Skampardonis: None

Dionysia Lourantou: None

Aris Antsaklis: None

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Authors and Affiliations

  1. First Department of Obstetrics and Gynecology, Urogynecology Unit, National & Kapodistrian University of Athens, “Alexandra” Hospital, 80 Vas. Sofias Avenue, 11528, Athens, Greece

    Stavros Athanasiou, Themos Grigoriadis, Dimitrios Zacharakis, Nikolaos Skampardonis, Dionysia Lourantou & Aris Antsaklis

Authors
  1. Stavros Athanasiou
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  2. Themos Grigoriadis
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  3. Dimitrios Zacharakis
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  4. Nikolaos Skampardonis
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  5. Dionysia Lourantou
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  6. Aris Antsaklis
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Correspondence to Stavros Athanasiou.

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Athanasiou, S., Grigoriadis, T., Zacharakis, D. et al. Seven years of objective and subjective outcomes of transobturator (TVT-O) vaginal tape: Why do tapes fail?. Int Urogynecol J 25, 219–225 (2014). https://doi.org/10.1007/s00192-013-2186-8

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