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

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.