Tension-free vaginal tape-obturator (TVT-O) for the treatment of female stress urinary incontinence (SUI) is safe and highly effective, according to results published in Neurourology and Urodynamics.
In an international multicentre study, 168 women underwent TVT-O implantation. Inclusion criteria were self-reported pure SUI symptoms in addition to urodynamically proven urodynamic stress incontinence (USI). After assessment at 1, 5 and 10 years, the authors report the most recent follow-up data of 157 evaluable patients at 13 years.
Both subjective and objective outcomes were assessed. At 13 years after surgery, 150 (95%) patients reported themselves cured, based on their responses to the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF), the Patient Global Impression of Improvement (PGI-I) scale and a patient-satisfaction scale. Objective cure, defined as the absence of urine leakage during a full-bladder stress test in the lithotomy and upright positions, was reported for 141 (90%) women.
Using the χ2 test for trend, Serati et al. report that time elapsed since treatment is not significantly associated with a decrease in cure rate for either subjective (P = 0.78) or objective (P = 0.10) cure. The cure rates at 1, 5 and 10 years were 95%, 95% and 97% for subjective cure and 95%, 91% and 92% for objective cure, respectively.
Factors that potentially contributed to recurrent subjective and objective USI (and, therefore, subjective and objective treatment failure) during the study period were also assessed: of the 14 variables assessed, obesity and previous anti-incontinence procedures each predicted subjective (P = 0.03 and P = 0.009, respectively) and objective (P = 0.04 and P = 0.01) failure of TVT-O.
In addition, the study reports a significantly higher risk of sling exposure after 10 years following treatment than before 10 years (P = 0.05), although the rate of exposure observed was low and sling exposure occurred in 4 of 157 (2.5%) women.
Serati, M. et al. TVT-O for treatment of pure urodynamic stress urinary incontinence: efficacy and adverse effects at 13-years follow-up. Neurourol. Urodyn. https://doi.org/10.1002/nau.24358 (2020)