Vaginal transobturator tape boosts incontinence cure rates

By Sally Robertson, B.Sc.Dec 31 2012

Implantation of tension-free vaginal transobturator tape (TVT-O) is a highly effective and long lasting treatment for women with stress urinary incontinence (SUI).

In a prospective study of women with urodynamically proven pure SUI, objective and subjective cure rates 5 years after TVT-O implantation were 90.8% and 90.3%, respectively, report Maurizio Serati (University of Insubria, Varese, Italy) et al.

"TVT-O seems to stand the test of time," they say in European Urology.

Very few data on TVT-O with more than 3 years of follow up are available and longer-term follow up is needed to compare outcomes between TVT-O and retropubic procedures for the treatment of female SUI because this is crucial for its management, explain the researchers.

The team reports that 12 months after TVT-O implantation, objective cure, defined as the absence of urine leakage during a stress test, was recorded for 168 (90.9%) of 187 women. Similarly, patient satisfaction scores on the International Consultation on Incontinence-Short Form [ICIQ-SF] and the Patient Global Impression of Improvement, showed that 171 (91.4%) of the women considered themselves cured.

In addition, at a 5-year follow-up assessment, objective cure was recorded for 168 (90.8%) of 185 women and subjective cure was reported by 167 (90.3%).

"It is noteworthy that our findings show a 5-yr cure rate that is definitely comparable to those reported by several papers with much shorter follow-up," say Maurizio and team.

Further analysis showed that a history of failed anti-incontinence procedures was the only significant predictor of objective and subjective failure of TVT-O, at hazard ratios of 3.7 and 4.4, respectively.

Furthermore, there was a very low incidence of early and postoperative complications, with only one case (bladder perforation) occurring across the study group. And late postoperative complication rates were also low, with recurrent urinary tract infections (UTIs) recorded for three women (1.6%) and groin pain for two women after 1 year of follow up. The slings were removed among those with UTIs, and the women who reported groin pain no longer did so at 5 years of follow up.

"TVT-O implantation shows a very high cure rate of women with pure SUI, with a low incidence of complications after 5 years of follow up," say the researchers.

However, the onset of de novo overactive bladder (OAB) symptoms was reported by 24.0% and 19.5% of patients at 1 and 5 years of follow up, respectively, and multivariate analysis did not reveal any significant predictor for OAB risk.

"The persisting postoperative onset of de novo OAB symptoms could be the most significant clinical issue related to TVT-O," concludes the team.

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