Mid-term and long-term safety and efficacy of TVT-O for the treatment of stress urinary incontinence

Objective To evaluate the complications and long-term efficacy of inside-out transobturator transvaginal tape(TVT-O) for the treatment of stress urinary incontinence(SUI). Methods From January 2008 to December 2013, 236 consecutive female patients(mean age 56±9 years, range 44-88 years)with the symptom of incontinence when abdominal pressure increasing (such as walking), underwent TVT-O operation. All these patients needed pads and were diagnosed with SUI by cough test and Marshall-bonny test before surgery, with the mean international consultation committee on incontinence questionnaire short form (ICI-Q-SF) score of 15.6±3.9. Two grouping methods were used: the mid-term group including patients whose follow-up time was between 6 months and 3 years, the long-term group including patients whose follow-up time >3 years, the group of patients who underwent TVT-O only and the group of patients who underwent TVT-O plus pelvic floor repair at the same time. Their clinical and follow-up data, intraoperative and postoperative complications, subjective and objective effects were recorded and analyzed. Results Of these 236 patients, there were 1 case of bladder perforation(0.4%) and 1 case of intraoperative sling exposure to vagina(0.4%). Postoperative complications included 36 (19.1%) groin/puncture point pain, 18 (9.5%) de novo frequency of micturition, 8 (4.2%) urinary retention /difficulty of urination. All the complications were relieved after symptomatic treatment or surgery except 2 cases of urinary retention/difficulty of urination. Their symptom kept existing after urethral dilatation and sling dissection and long-term intermittent self-catheterization was needed. One hundred and eighty-nine patients completed more than six months of follow-up, with mean follow-up time of (35.0±12.5) months. One hundred and sixteen(61.4%) cases was arranged to mid-term group and 73(38.6%) was arranged to long-term group. 88.9% patients (168/189) were cured objectively and 9.5% patients (18/189) improved. There was also a significant subjective improvement (ICI-Q-SF scores: 15.6±3.9 preoperative versus 6.7±2.3 postoperative, P 0.05). Patients who underwent TVT-O and those who underwent TVT-O + pelvic floor repair had no significant difference in efficacy (cured + improved rate 97.8% versus 100.0%, P>0.05). Conclusion TVT-O is a safe, effective and durable treatment for SUI, whether or not with concomitant procedure of pelvic floor repairment. Key words: Urinary incontinence, stress; Transobturator approach for transvaginal tape; Sling