[Long-term efficacy of TVT procedure in the treatment of stress urinary incontinence].

OBJECTIVE OF THE STUDY: The objective of the study was to ascertain the long-term efficacy of TVT procedure in the treatment of stress urinary incontinence.

DESIGN: Prospective observational study.

SETTINGS: Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and the General University Hospital, Prague, EuroMISE centre of the Academy of Science, Prague.

MATERIAL AND METHODS: 111 women with urodynamically proven stress incontinence who had undergone a TVT operation were included in the study; patients suffering with the mixed type of incontinence were included as well while a major prolapse of anterior vaginal wall (POP-Q II and more) was applied as the exclusion criterion. An overall pre-operation examination was carried out, including urodynamic and ultrasound examination, while the patients also completed an i-QOL quality of life questionnaire. The success of the operation was assessed using objective and subjective parameters. Occurrence of post-operation complications was correlated to the pre-operation mobility of the urethra, the surgeon who carried out the procedure, the post-operation position and mobility of the tape.

RESULTS: Of the 111 patients, 105 appeared for the 3-month post-operation check. Another 10 failed to appear for the one year check, and yet another 10 dropped out from the subsequent monitoring. A failure of the procedure was subsequently described for 9 patients (8.1%), who had to undergo another procedure: for 7 patients a re-operation was carried out to treat recurrence of the stress urinary incontinence, and for 2 patients discision of the tape was carried out for the reason of problems with urine retention and repeated infections of urinary tract. At the beginning of the post-operation monitoring 80% of patients were objectively stress continent. At the end of the monitoring, 74% of women were fully continent and 15% subjectively improved, with objectively proved SI. We have, however, observed a relatively higher increase in de novo urgency, where at the beginning of the monitoring, 10% of patients were thus affected, and at the end of the monitoring 22.5%. At the end of the monitoring the tape is 20% narrower and 2 mm closer to the urethra; otherwise its position unchanged. We have not proved that the pre-operation mobility of the urethra or choice of surgeon would affect the results of the operation. Neither have we proved any difference in the position and mobility of the tape in relation to the result of the operation.

CONCLUSIONS: In our group of patients we have proved very good long-term efficacy of the TVT operation for treatment of stress urinary incontinence. We have, nevertheless, observed a rather high increase in de novo occurrence of urgency at the end of the monitoring period - 21%. The increase of de novo urgency might be explained by the change in the position of the tape, which is closer to the urethra at the end of the monitoring.