Tension-Free Vaginal Tape for the Treatment of Stress Urinary Incontinence in Geriatric Patients

Abstract

Objective: To evaluate the safety and efficacy of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in geriatric patients. Patients and Methods: Fifty-one women, aged 65–80 (mean 72.3) years, underwent a TVT procedure for genuine SUI from 2001 to 2004. A urodynamic test together with uroflowmetry were performed. The patients’ SUI bother score was assessed using a visual analog scale (VAS). Results: The mean operative time was 25 (range 14–29) min and mean hospitalization time was 1.2 (range 1–2) days. Bladder perforation occurred in 3 cases (5.8%) and was managed conservatively. Pre- and postoperative maximum flow rate were not significantly different (p > 0.05). The patients’ SUI bother score estimated by the VAS was statistically significantly improved (p < 0.0001). After a mean follow-up of 35.6 (range 14–60) months, 49 patients (96%) had no SUI, while 2 patients (3.9%) had persistent SUI. Also, during the follow-up 5 patients (9.8%) were diagnosed with de novo urgency due to detrusor overactivity and 1 patient (1.9%) had persistent dysuria that was resolved with urethrolysis. Conclusions: SUI in elderly women can be safely treated with the TVT procedure in the vast majority of the patients. However, bladder perforation during surgery and de novo urgency postoperatively should be taken into account.

Midurethral sling procedures for stress urinary incontinence in women over 80 years

“…The rate of long‐term subjective voiding difficulty in our study was similar between elderly and younger patients (8% vs. 6%, P = 0.21). Consistent with previous studies,2, 4, 25 the rate of tape division in our group was quite low. Two elderly (2%) and 10 younger patients (1%) required tape division because of ongoing voiding difficulty.…”

“…The bladder perforation rate in our study was similar (3%) in both age groups. Previous studies2, 3, 6, 7, 24 did not find that age is a risk factor for bladder perforation. Only one study4 demonstrated significantly fewer cases of bladder perforation among elderly women (1.3% vs. 4.9%, P < 0.05).…”

“…As the population of elderly women increases, so will the demand for effective surgical management of SUI in this group. Previous studies have suggested that the retropubic sling is a safe and efficient procedure which significantly improves the quality of life of elderly women 1–9. However, in these studies the majority of the women were younger than 80 years and the analyses did not include transobturator slings.…”

Surgery for urinary incontinence in women 65 years and older: a systematic review

“…1) [9][10][11][12][13][14][15][16][17]. Four of those were not included in the analysis because of the high risk of bias (low study quality) [10,13,15,17]. This was due to small populations, the lack of description of those lost to follow-up and/or lack of a control group.…”