The tension-free vaginal tape in women with a non-hypermobile urethra and low maximum urethral closure pressure

Abstract

The objective of this study was to estimate the cure rate and to identify risk factors that predict failure of the tension-free vaginal tape (TVT) in women with stress urinary incontinence (SUI), a non-hypermobile urethra, and low maximum urethral closure pressure. Thirty-six women with SUI, a non-hypermobile urethra (straining urethral angle<or=35 degrees), and low maximum urethral closure pressure (MUCP<or=25 cm H2O) underwent a TVT. Cure was defined as resolution of subjective SUI symptoms and a negative cough stress test, which were measured after 4, 12, 18, and 24 months. Patient characteristics were compared and receiver-operator curves were used to identify risk factors for failure. The mean age was 71 years, and mean follow-up was 20.9 months. The overall cure rate was 78%. Risk factors for failure of the TVT were a straining urethral angle<or=20 degrees (cure rate 50%, odds ratio 7.7, p=0.02) and a MUCP<or=15 cm H2O (cure rate 60%, odds ratio 6.3, p=0.03). For women with both risk factors, the cure rate was only 17% (p<0.001). No other risk factors were identified. The TVT has moderate success (50-60%) for women with SUI and one risk factor (a straining urethral angle<or=20 degrees or a MVCP<or=15 cm H2O), but has poor success (17%) when both risk factors are present.

Baseline Urodynamic Predictors of Treatment Failure 1 Year After Mid Urethral Sling Surgery

“…Most studies of retropubic slings have shown that measures of VLPP and MUCP were not associated with surgical success rates. [10–13] A recent metanalysis confirmed that urethral function did not predict outcome of MUS, regardless of approach. [14] In a randomized surgical trial of transobturator and retropubic MUS, Barber et al reported that VLPP, considered either as a continuous or dichotomous variable (<60 cm/H 2 O) was not associated with failure of either procedure after one year.…”

Effectiveness of midurethral slings in intrinsic sphincteric-related stress urinary incontinence

“…In a prospective series of 174 patients undergoing distal to midurethral retropubic polypropylene Effectiveness of MUS in ISD and SUI Lim and Dwyer 429 slings, Rodriguez et al [30] found no significant differences in efficacy in patients with various different VLPP values. Table 1 shows a summary of studies investigating the outcome of TVT in an ISD setting [31][32][33][34][35][36][37][38]. Overall, it would appear that retropubically placed TVT are effective in treating women with both urinary stress incontinence (USI) and ISD, although with some studies showing slightly lower cure rates.…”

Long-term follow-up of the retropubic tension-free vaginal tape procedure

“…However, although these are statistical differences, the clinical significance is probably negligible, as the differences are small. If any clinical relevance should be assigned to these differences, it would be that this adds strength to the favourable outcome results for the participants, due to the fact that both a low MUCP (121) For the POSUI study (Paper III), we also wanted to test for selection bias (post study analysis). We did this by comparing study-women to other women having had POP surgery in the same time period at our Department, but who for some reason did not participate in the study.…”