The subjective and objective very long-term outcomes of TVT in the COVID era: A 20-year follow-up

Abstract

Introduction and hypothesis Few studies in literature have assessed the long-term durability and mesh-related complications of mid-urethral slings (MUSs). The aim of this study is to assess the efficacy and safety of retro-pubic tension-free vaginal tape (TVT) 20 years after implantation for the treatment of female stress urinary incontinence (SUI). Methods A prospective observational study was conducted in two urogynaecologic units in two countries. All the patients involved were consecutive women with urodynamically proven pure SUI treated by TVT. The patients underwent preoperative clinical and urodynamic evaluations. Subjective outcomes, objective outcomes and adverse events were recorded during the follow-up period. Results Fifty-two patients underwent a TVT surgical procedure. Twenty years after surgery, 32 out of 36 patients (88.8%) declared themselves cured (p = 0.98). Similarly, 33 out of these 36 patients (91.7%) were objectively cured (p = 0.98). No significant deterioration of subjective and objective cure rates was observed over time (p for trend 0.50 and 0.48). Fifteen of the 36 patients (41.6%) at the 20-year follow-up reported the onset of de novo overactive bladder (OAB) (p = 0.004). No significant vaginal bladder or urethral erosion or de novo dyspareunia was recorded and no patient required tape release or resection during this period. The cause of death of seven out of ten women who died in the last year of the follow-up period was coronavirus disease 19 (COVID 19). Conclusions The 20-year results of this study showed that TVT is a highly effective and safe option for the treatment of SUI. The impact of COVID 19 on the mortality rate of elderly women has drastically reduced the number of eligible patients for future evaluations in our region.

Medium Term Outcomes of TVT-Abbrevo for the Treatment of Stress Urinary Incontinence: Efficacy and Safety at 5-Year Follow-Up

“…As previously reported at the 3-year follow-up [ 9 ], the trend of de novo OAB was significantly increased at the final 5-year evaluation. The rate of the onset of de novo OAB did not differ from the traditional MUSs [ 2 , 3 , 29 ], and it is comparable with previous published data on the TVT-A [ 27 ]. Although we know that antimuscarinic treatment of patients with de novo OAB after MUS implantation is associated with lower efficacy [ 19 ], in our series, patients who started an antimuscarinic treatment for de novo OAB seemed to respond slightly better than with TVT-O [ 29 ].…”

“…Our findings suggest that TVT-A is a safe and highly effective procedure for the treatment of SUIs, even in mid-term and long-term follow-up. Although not statistically significant, there seemed to be a slight trend of efficacy reduction with time (from over 95 to 84–88%), and the long-lasting benefits seem to be slightly lower than traditional MUSs (TVT, TVT-O) [ 2 , 3 , 29 ]; however, more studies with a large sample size are needed to demonstrate this.…”

“…After failure of conservative treatment, the mid-urethral sling (MUS) is considered the most effective and safe surgical procedure for SUI [ 2 , 3 ]. However, its efficacy has recently been questioned due to reports of vaginal mesh complications.…”

Acceptability and perceived value of urodynamics from the patient perspective: A narrative review

“…In our opinion, clinicians should utilize UDS whenever it can improve understanding of the pathophysiology of urinary dysfunction and thereby guide management decision‐making. Urodynamics also enables clinicians to provide informed explanations to patients about the underlying cause of their symptoms 29,30 Unfortunately, over the last 2 years, the use of urodynamics – like other urological and urogynecological interventions – has been dramatically impacted by the COVID‐19 pandemic 31 . We anticipate that the absence of urodynamic assessment will have heightened the chances of misdiagnosis and inappropriate management decisions, especially in “complicated patients,” a daunting problem that we will have to face in the coming years.…”

The Potential of Non-ablative Erbium (YAG) Laser Treatment for Complications After Midurethral Sling Surgery: A Narrative Review

“…Braga et al conducted a 20-year follow-up after TVT surgery and found long-term complications, such as mesh exposure (6.3%), de novo urge incontinence (6.9%), and recurrence (12.5%). They emphasized the importance of early detection and treatment intervention through regular symptom assessment and cystoscopy [ 54 ]. Khanuengkitkong et al reported a case of mesh exposure 10 years after TVT surgery and stressed the need for regular follow-up, even in asymptomatic cases [ 55 ].…”