Is the tension-free vaginal tape procedure for stress urinary incontinence safe and effective in the long term?

Abstract

This Practice Point discusses the study by Nilsson and colleagues, who reported the first 10-year follow-up outcome analysis of patients who underwent a tension-free vaginal tape procedure for stress urinary incontinence. The study, however, leaves some issues open to question. Long duration of follow-up is a strength of the study, but also presents problems associated with patients' recall. Subjective outcome assessment might change as a patient ages, and clinical evidence suggests that differences in subjective outcomes exist between short-term and longer-term follow-up. In addition, Nilsson et al. did not report functional complications or healing abnormalities. De novo storage symptoms are not negligible after tension-free vaginal tape procedures; nor are healing abnormalities (e.g. mesh erosion). Clear guidelines need to be developed for the long-term outcome assessment of urinary incontinence and its treatments, and subjective outcomes must be adequately incorporated into evaluation.