LONG-TERM EFFICACY AND RISK FACTORS FOR SURGICAL FAILURE OF TVT-O

Tommaso Realfonso1, Giorgio Napodano1, Giovanni Molisso1, Umberto Di Mauro1, Roberto Sanseverino1
  • 1 Ospedale Umberto I, U.O.C. Urologia (Nocera Inferiore)

Objective

The short-medium term outcomes after TVT-O are quite known in the literature. Less known are the long-term results. With this retrospective study we wanted to examine the functional aspects, complications and the possible risk factors in the failure, after the TVT-O placement in a long time.

Materials and Methods

Hundred twenty-five patients who had undergone a period of twelve years of TVT-O positioning operation for stress urinary incontinence were evaluated retrospectively. One urogynecological team has performed all procedures. The patients had stress urinary incontinence (SUI) and had undergone Urodynamics (UDS). They excluded women with a history of previous surgery for incontinence or radical pelvic surgery and those with hyperactivity 'detrusor overactivity (DO). They were considered objectively cured patients who had no urinary leakage during cough stress test (CST). Subjective outcomes were assessed using the Incontinence Questionnaire for Evaluating Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). The quality of life was measured with the King's Health Questionnaire (KHQ). To identify risk factors for the failures of the procedure have been used univariate and multivariate analyzes.

Results

The median follow-up was 102 months (range 72-144). 78.9% (98/125) of patients were objectively cured, while 80.4% (100/125) are subjectively cured. A significant improvement was observed in all domains of the KHQ. De novo urgency rate was 10% (12/125). The incidence of subjective and objective failures did not show statistically significant increases in relation to the length of follow-up. The patients who had undergone a vaginal hysterectomy or with apical prolapse had a higher and statistically significant risk of failure. The intraoperative complications were: perforation of the vaginal fornix in two patients, bleeding stopped with intravaginal compression in two patients, pain lasting more than seven days in the thighs 15%. Transient dyspareunia and less than one month in the 4%. No cases of vaginal erosion or bladder perforation.

Discussions

Several studies have confirmed the safety and short-term efficacy of the TVT-O. The procedure is technically simple, is associated with a short learning curve, a short operating time and low morbidity. French registry data on 984 TVT-O procedures showed a perioperative morbidity rate of 2.2% and a postoperative complication rate of 5.2%.4 The most common complication was residual pain (2.7%). The other complications of paravesical hematoma, urinary retention, vaginal erosion, and reintervention had an incidence of < 1%. These studies, along with several randomized trials, confirm that short-term and mediumterm outcome results of the TVT-O are favorable and similar to the results of the retropubic TVT. Long-term outcome results of the TVT-O procedure are scarce. Several recent studies have demonstrated that the incidence of perioperative and short-term postoperative complications associated with the TVT-O procedure is low. In our study, no patient presented symptoms/signs suggestive of vagina, bladder, or urethral erosion; neurologic complication; or persistent pain with 144 months follow-up.

Conclusion

An 21% rate of surgical failure was observed with median 102 months follow-up without significant increase over the duration of follow-up. There are no recorded cases of women with symptoms/signs suggestive of vagina, bladder, or urethral erosion; neurologic complication; or persistent pain with 144 months follow-up. De novo urgency rate was 10%. The positioning of TVT-O is characterized by a high long-term effectiveness, determines a significant improvement on the quality of life of patients and the relative technique has a high degree of safety. The vaginal hysterectomy and apical prolapse are significantly associated with an increased risk of subjective and objective failures.

References

Collinet P, Ciofu C, Costa P, et al. The safety of the insideouttransobturator approach for transvaginal tape (TVT-O) treatment in stress urinary incontinence: French registry
data on 984 women. Int Urogynecol J 2008;19:711–715.

Waltregny D, Gaspar Y, Reul O, et al. TVT-O for the treatment of female stress urinary incontinence: Results of a prospective study after a 3-year minimum follow-up. Eur
Urol 2008;53:401–408

Liapis A, Bakas P, Creatsas G. Efficacy of inside-out transobturator vaginal tape (TVT-O) at 4 years follow-up. Eur J Obstet Gynecol Reprod Biol 2010;148199–201.

Argomenti: