Tension-free vaginal tape procedure for urinary incontinence with low Valsalva leak point pressure.

PURPOSE: We evaluated the outcome of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence with low Valsalva leak point pressure (VLPP) and identified factors predicting the outcome.

MATERIALS AND METHODS: A total of 221 women 29 to 80 years old (mean age 55.2) were included in the study. The TVT procedure was performed mostly using local anesthesia. Mean followup was 10.5 months (range 6 to 52). Patients were divided into 61 with low (less than 60 cm H2O) and 160 with higher (60 cm H2O or greater) VLPP. Cure of incontinence was defined as an absent subjective complaint of leakage and absent objective leakage on stress testing.

RESULTS: The overall cure rate was significantly lower in patients with low vs higher VLPP (82.0% vs 93.1%, p = 0.013). In women with low VLPP multivariate analysis indicated that urge symptoms and low maximal urethral closure pressure were independent factors for treatment failure (OR 15.12, 95% CI 1.90 to 120.61, p = 0.010 and OR 0.92, 95% CI 0.86 to 0.99, p = 0.018, respectively).

CONCLUSIONS: The cure rate after the TVT procedure is lower in women with VLPP less than 60 cm H2O compared to those with higher VLPP. Our findings suggest that women with urge symptoms and low maximal urethral closure pressure should be considered to be at high risk for failure after the TVT procedure.