Document Detail


TVT-O for the treatment of pure urodynamic stress incontinence: efficacy, adverse effects, and prognostic factors at 5-year follow-up.
MedLine Citation:
PMID:  23274106     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Inside-out tension-free vaginal transobturator tape (TVT-O) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI), but data reporting long-term outcomes are scarce.
OBJECTIVE: To evaluate the efficacy and safety of TVT-O 5-yr implantation for management of pure SUI in women.
DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study was conducted in four tertiary reference centers. Consecutive women presenting with urodynamically proven, pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded.
INTERVENTION: TVT-O implantation without any associated procedure.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Data regarding subjective outcomes (International Consultation on Incontinence-Short Form [ICIQ-SF], Patient Global Impression of Improvement, patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Multivariable analyses were performed to investigate outcomes.
RESULTS AND LIMITATIONS: Of the 191 women included, 21 (11.0%) had previously undergone a failed anti-incontinence surgical procedure. Six (3.1%) patients were lost to follow-up. The 5-yr subjective and objective cure rates were 90.3% and 90.8%, respectively. De novo overactive bladder (OAB) was reported by 24.3% of patients at 5-yr follow-up. Median ICIQ-SF score significantly improved from 17 (interquartile range [IQR]:16-17) preoperatively to 0 (IQR: 0-2) (p<0.0001). Failure of a previous anti-incontinence procedure was the only independent predictor of subjective recurrence of SUI (hazard ratio [HR]: 4.4; p = 0.009) or objective (HR: 3.7; p = 0.02). No predictive factor of de novo OAB was identified.
CONCLUSIONS: TVT-O implantation is a highly effective option for the treatment of women with pure SUI, showing a very high cure rate and a low incidence of complications after 5-yr follow-up.
Authors:
Maurizio Serati; Ricarda Bauer; Jean Nicolas Cornu; Elena Cattoni; Andrea Braga; Gabriele Siesto; Daphné Lizée; François Haab; Marco Torella; Stefano Salvatore
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2012-12-20
Journal Detail:
Title:  European urology     Volume:  63     ISSN:  1873-7560     ISO Abbreviation:  Eur. Urol.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-01     Completed Date:  2013-09-24     Revised Date:  2014-08-26    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  872-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Chi-Square Distribution
Europe
Female
Humans
Logistic Models
Middle Aged
Multivariate Analysis
Patient Satisfaction
Postoperative Complications / etiology
Prospective Studies
Recovery of Function
Recurrence
Risk Factors
Suburethral Slings*
Tertiary Care Centers
Time Factors
Treatment Outcome
Urinary Incontinence, Stress / diagnosis,  physiopathology,  surgery*
Urodynamics*
Urologic Surgical Procedures / adverse effects,  instrumentation*
Comments/Corrections
Comment In:
J Urol. 2014 Aug;192(2):489   [PMID:  25035016 ]
Eur Urol. 2013 May;63(5):879-80   [PMID:  23352654 ]

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