Factors influencing outcome following the tension-free vaginal tape (TVT)

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Abstract

Objectives

To evaluate factors influencing the outcome with tension-free vaginal tape (TVT).

Study design

A prospective questionnaire survey of 100 women undergoing TVT between January 2006 and May 2007 for urodynamic stress incontinence. All women were assessed pre-operatively and 3 months post-operatively using a validated electronic pelvic floor symptoms assessment questionnaire (ePAQ). Using linear regression, the influence of age, severity of stress incontinence and pre-existing lower urinary tract symptoms (LUTS) were assessed on symptomatic improvement of stress urinary incontinence and on quality of life (QoL).

Results

Women with more severe symptoms preoperatively had a significantly greater improvement in stress incontinence symptoms (p < 0.001) and quality of life (p = 0.016). Age and pre-existing LUTS were not associated with adverse outcomes with surgery in terms of improvement in stress incontinence or quality of life.

Conclusions

Women with more severe stress urinary incontinence may expect greater improvement, both in their stress incontinence and their health-related quality of life (HRQoL) following a TVT. Age and coexisting lower urinary tract symptoms do not impact significantly on TVT outcomes in terms of the reduction in stress incontinence or improvement in HRQoL.

Introduction

Surgery for stress incontinence has been performed for over a century, and over the past 15 years the tension-free vaginal tape (TVT) has become the surgical procedure of choice with high success rates, relatively low complication rates and rapid recovery compared with colposuspension [1]. It is important when contemplating this procedure that patients are given realistic expectations of outcome and complications so that decisions can be based on good evidence. It is clearly valuable to have an awareness of which patients are more likely or less likely to benefit from surgery, thus enabling appropriate counseling and patient selection.

Several studies have reported on the effect of factors impacting on TVT outcome. However, when looking at the effect of age, the results are variable. For example, whilst some studies show that older age is an adverse prognostic indicator [2], [3], [4], others show no effect [5] and one study suggested that older women respond better to incontinence surgery [6].

Traditionally, lower urinary tract symptoms such as urgency and urge incontinence have been considered to be adverse prognostic indicators [7], [8]. However, little is known about the influence of symptom severity on the outcome and overall symptom improvement.

The objective of this study was to use regression analysis in a large prospectively collected data set from a validated electronic pelvic floor symptoms assessment questionnaire (ePAQ-PF). We aimed to identify factors influencing the outcome of TVT, with particular emphasis on age, severity of stress incontinence, pre-existing overactive bladder, bladder pain and voiding dysfunction on outcome in terms of symptomatic improvement in stress urinary incontinence and health-related quality of life (HRQoL). We also aimed to evaluate the effect of age on changes in lower urinary tract symptoms (LUTS) following TVT in terms of overactive bladder (OAB) symptoms, bladder pain and voiding dysfunction.

Section snippets

Material (patients) and methods

This prospective observational study included 100 consecutive patients undergoing TVT for the treatment of stress urinary incontinence (USI) from January 2006 to May 2007. All women completed the validated ePAQ-PF [9] pre-operatively and again 3 months post-operatively. Women undergoing concomitant prolapse surgery were excluded. All women underwent pre-operative urodynamics. Women included in the study were those with Urodynamic stress incontinence (USI) or mixed incontinence. All women with

Results

Pre-operative urodynamic results found 85% of women had USI and 15% had mixed incontinence (USI + DOA). Overall, women with mixed incontinence were equally likely to have a 20-point improvement in stress incontinence as women with pure USI, with no significant differences in post-operative overactive bladder (OAB) symptoms between these 2 groups (Table 1).

All dimensions (USI, OAB, QoL, VD and pain) on the urinary domain were improved following a TVT irrespective of age (Table 2). There was a

Conclusions

Women with more severe symptoms preoperatively have greater improvement, both in stress incontinence and HRQoL scores following TVT. The age of the patient and presence of other lower urinary tract symptoms do not impact significantly on the outcome of TVT in terms of reduction in stress incontinence or improvement in quality of life. This is the first study looking at the effect of pre-existing symptom severity on the outcome of surgery, both in terms of symptomatic improvement and improvement

Conflict of interest

Stephen Radley is a board member and shareholder of ePAQ Systems Limited.

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