L Jeffry1, B Deval, A Birsan, D Soriano, E Daraï. 1. Service de Gynécologie, Hôpital Hôtel-Dieu de Paris, Assistance Publique des Hôpitaux de Paris, Paris, France.
Abstract
OBJECTIVES: To assess the objective and subjective cure rates after the tension-free vaginal tape (TVT) procedure in women with urinary incontinence. METHODS: We performed a retrospective analysis of 112 consecutive women with genuine stress (n = 88) and mixed (n = 24) incontinence. The objective cure rate was evaluated by clinical and urodynamic examinations and the subjective cure rate using the Contilife questionnaire. The mean follow-up time was 25 months (range 18 to 34). RESULTS: The mean operative time was 30 minutes (range 25 to 50). Most patients (58%) underwent surgery with locoregional anesthesia. The overall complication rate was 37.5% (42 of 112). The perioperative complication rate was 14.3%, including 13 bladder injuries (11.6%). Five (38.5%) of the latter occurred in 7 patients with a previous history of incontinence surgery (P <0.001). The early postoperative complication rate was 32.1%. The main complication was voiding difficulties, diagnosed in 14 patients. Ten (71.4%) required intermittent self-catheterization for less than 15 days and four for a mean duration of 28 days (range 15 to 90). The late postoperative complication rate was 29.4%, including 29 cases of de novo urge symptoms (25.9%). Anticholinergic drugs were effective in only 15 (51.7%) of the 29. The objective cure rate was 89.3%. No difference was found between patients with genuine stress incontinence and those with mixed incontinence. The subjective cure rate was 66%. The difference in cure rates between the objective and subjective evaluations was significant (P <0.05). The subjective cure rate in patients with de novo urge symptoms was 37.9%. CONCLUSIONS: Our results demonstrate that the TVT procedure is a safe and effective surgical method. The lower subjective cure rate was related to the high incidence of de novo urge symptoms.
OBJECTIVES: To assess the objective and subjective cure rates after the tension-free vaginal tape (TVT) procedure in women with urinary incontinence. METHODS: We performed a retrospective analysis of 112 consecutive women with genuine stress (n = 88) and mixed (n = 24) incontinence. The objective cure rate was evaluated by clinical and urodynamic examinations and the subjective cure rate using the Contilife questionnaire. The mean follow-up time was 25 months (range 18 to 34). RESULTS: The mean operative time was 30 minutes (range 25 to 50). Most patients (58%) underwent surgery with locoregional anesthesia. The overall complication rate was 37.5% (42 of 112). The perioperative complication rate was 14.3%, including 13 bladder injuries (11.6%). Five (38.5%) of the latter occurred in 7 patients with a previous history of incontinence surgery (P <0.001). The early postoperative complication rate was 32.1%. The main complication was voiding difficulties, diagnosed in 14 patients. Ten (71.4%) required intermittent self-catheterization for less than 15 days and four for a mean duration of 28 days (range 15 to 90). The late postoperative complication rate was 29.4%, including 29 cases of de novo urge symptoms (25.9%). Anticholinergic drugs were effective in only 15 (51.7%) of the 29. The objective cure rate was 89.3%. No difference was found between patients with genuine stress incontinence and those with mixed incontinence. The subjective cure rate was 66%. The difference in cure rates between the objective and subjective evaluations was significant (P <0.05). The subjective cure rate in patients with de novo urge symptoms was 37.9%. CONCLUSIONS: Our results demonstrate that the TVT procedure is a safe and effective surgical method. The lower subjective cure rate was related to the high incidence of de novo urge symptoms.
Authors: Alexis A Dieter; Autumn L Edenfield; Alison C Weidner; Pamela J Levin; Nazema Y Siddiqui Journal: Int Urogynecol J Date: 2014-05-09 Impact factor: 2.894