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Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence.
Eur J Obstet Gynecol Reprod Biol. 2007 Sep; 134(1):87-94.EJ

Abstract

OBJECTIVES

Prospective evaluation of outcome and complications over a 5-year period post-treatment of urinary stress incontinence by TVT, and comparison of our results with the reference studies.

MATERIALS AND METHODS

About 94 patients were treated for urinary stress incontinence only by one TVT procedure (single surgical procedure), between April 1997 and December 1998; 68% of patients presented pure urinary stress incontinence and 32% mixed incontinence. We found also a 25.5% rate of sphincter deficiency (UCP < 20 cm H(2)O) in this cohort. Patients were evaluated after 5 years: 52 complete evaluations (clinical, flow measurement with measurement of post-mictional residue, 24h PAD-test, quality of life questionnaire), 30 complete telephone interviews, 12 lost to follow-up (2 patients deceased).

RESULTS

About 87% of the patients had a 5-year follow-up. The success rate was 79.2% overall (84.5% for the pure urinary stress incontinence and 67% for the mixed incontinence cases), and 72.2% for the cases of associated sphincter deficiency. We had only a 13% rate of patients lost to follow-up. More than half of the urinary urgency cases were treated successfully, however with a less satisfactory outcome in cases of bladder instability. The urodynamic exploration appeared to reveal that TVT caused dysuria: 52% of patients had a maximum flowrate below 15 ml/s, but the quality of life was improved, with a 95% rate of satisfaction without functional problems. We observed no late complications such as vaginal erosion or rejection of the prolene; the de novo syndrome was rare, with 8.5% of urinary frequency, 6% of urinary urgency and only 5.7% of invalidating dysuria. We saw no cases of pelvic floor disease after TVT treatment.

DISCUSSION

Our casuistry results are comparable with the reference studies by Scandinavian authors, Rezapour and Ulmsten, confirming the long-term success of the TVT procedure. Concerning the apparently elevated rates of post-TVT dysuria found by urodynamic exploration, a distinction has to be drawn between post-TVT urinary problems (frequent but oligosymptomatic), and true, severe dysuria (rare). However, "dysuria" in the broad sense did not affect the patients' quality of life, and is a reminder of the absolute necessity of meticulous compliance with the correct surgical techniques.

CONCLUSION

Treatment of urinary incontinence by TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications; it is inexpensive and very successful, including in complicated cases such as sphincter deficiency. All the recent data confirms, with this 5-year follow-up, that the TVT procedure is comparable to the previously gold standard, the Burch colposuspension.

Authors+Show Affiliations

Urogynaecology Unit, Maternity Hôtel-Dieu, Clermont-Ferrand University Hospital, 11 Boulevard Léon Malfreyt, 63058 Clermont-Ferrand Cedex 1, France. chenegautier@yahoo.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16891051

Citation

Chêne, G, et al. "Long-term Results of Tension-free Vaginal Tape (TVT) for the Treatment of Female Urinary Stress Incontinence." European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 134, no. 1, 2007, pp. 87-94.
Chêne G, Amblard J, Tardieu AS, et al. Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence. Eur J Obstet Gynecol Reprod Biol. 2007;134(1):87-94.
Chêne, G., Amblard, J., Tardieu, A. S., Escalona, J. R., Viallon, A., Fatton, B., & Jacquetin, B. (2007). Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 134(1), 87-94.
Chêne G, et al. Long-term Results of Tension-free Vaginal Tape (TVT) for the Treatment of Female Urinary Stress Incontinence. Eur J Obstet Gynecol Reprod Biol. 2007;134(1):87-94. PubMed PMID: 16891051.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence. AU - Chêne,G, AU - Amblard,J, AU - Tardieu,A S, AU - Escalona,J R, AU - Viallon,A, AU - Fatton,B, AU - Jacquetin,B, Y1 - 2006/08/07/ PY - 2005/12/02/received PY - 2006/05/11/revised PY - 2006/06/13/accepted PY - 2006/8/8/pubmed PY - 2008/1/4/medline PY - 2006/8/8/entrez SP - 87 EP - 94 JF - European journal of obstetrics, gynecology, and reproductive biology JO - Eur J Obstet Gynecol Reprod Biol VL - 134 IS - 1 N2 - OBJECTIVES: Prospective evaluation of outcome and complications over a 5-year period post-treatment of urinary stress incontinence by TVT, and comparison of our results with the reference studies. MATERIALS AND METHODS: About 94 patients were treated for urinary stress incontinence only by one TVT procedure (single surgical procedure), between April 1997 and December 1998; 68% of patients presented pure urinary stress incontinence and 32% mixed incontinence. We found also a 25.5% rate of sphincter deficiency (UCP < 20 cm H(2)O) in this cohort. Patients were evaluated after 5 years: 52 complete evaluations (clinical, flow measurement with measurement of post-mictional residue, 24h PAD-test, quality of life questionnaire), 30 complete telephone interviews, 12 lost to follow-up (2 patients deceased). RESULTS: About 87% of the patients had a 5-year follow-up. The success rate was 79.2% overall (84.5% for the pure urinary stress incontinence and 67% for the mixed incontinence cases), and 72.2% for the cases of associated sphincter deficiency. We had only a 13% rate of patients lost to follow-up. More than half of the urinary urgency cases were treated successfully, however with a less satisfactory outcome in cases of bladder instability. The urodynamic exploration appeared to reveal that TVT caused dysuria: 52% of patients had a maximum flowrate below 15 ml/s, but the quality of life was improved, with a 95% rate of satisfaction without functional problems. We observed no late complications such as vaginal erosion or rejection of the prolene; the de novo syndrome was rare, with 8.5% of urinary frequency, 6% of urinary urgency and only 5.7% of invalidating dysuria. We saw no cases of pelvic floor disease after TVT treatment. DISCUSSION: Our casuistry results are comparable with the reference studies by Scandinavian authors, Rezapour and Ulmsten, confirming the long-term success of the TVT procedure. Concerning the apparently elevated rates of post-TVT dysuria found by urodynamic exploration, a distinction has to be drawn between post-TVT urinary problems (frequent but oligosymptomatic), and true, severe dysuria (rare). However, "dysuria" in the broad sense did not affect the patients' quality of life, and is a reminder of the absolute necessity of meticulous compliance with the correct surgical techniques. CONCLUSION: Treatment of urinary incontinence by TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications; it is inexpensive and very successful, including in complicated cases such as sphincter deficiency. All the recent data confirms, with this 5-year follow-up, that the TVT procedure is comparable to the previously gold standard, the Burch colposuspension. SN - 0301-2115 UR - https://www.unboundmedicine.com/medline/citation/16891051/Long_term_results_of_tension_free_vaginal_tape__TVT__for_the_treatment_of_female_urinary_stress_incontinence_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0301-2115(06)00357-5 DB - PRIME DP - Unbound Medicine ER -