Urogynaecology: Effect of tension‐free vaginal tape in women with a urodynamic diagnosis of idiopathic detrusor overactivity and stress incontinence

Abstract

Objective To determine the effect of tension-free vaginal tape (TVT) in women with idiopathic detrusor overactivity (DO) and urodynamic stress incontinence (USI) and to propose appropriate pre-operative counselling based on this information.Design Retrospective cohort study.Setting Urogynaecology Unit, District General Hospital, Kent.Population Fifty-one women (from a total of 344 women undergoing TVT) with urodynamic evidence of both DO and USI who underwent TVT insertion between November 1999 and March 2003.Methods Women with more than six-month follow up were assessed objectively with cystometry. Subjective results were assessed using structured interview and condition specific Kings Quality of Life Questionnaire.Main outcome measures Objective resolution of DO and subjective absence of urge syndrome after TVT. Cure of USI was the secondary outcome measure analysed. The effect of drug therapy on residual urge symptoms was assessed.Results Objective cure of DO was demonstrated in 47% and subjective cure of urge symptoms in 63%. In women with persistent urge symptoms, the addition of anticholinergic medication resulted in resolution of urge incontinence in a further 22% of women. USI was objectively cured in 92%.Conclusions More than 60% of women diagnosed urodynamically with DO and USI experience complete resolution of urge symptoms following TVT. Further symptom improvement can be achieved with additional anticholinergic medication.Please cite this paper as: Duckett J, Tamilselvi A. Effect of tension-free vaginal tape in women with a urodynamic diagnosis of idiopathic detrusor overactivity and stress incontinence. BJOG 2006; 113:30-33

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

“…Anticholinergics are the treatment of choice for this complication with very good results [19] . Recently, it was demonstrated that more than 60% of women diagnosed urodynamically with detrusor overactivity and SUI experience complete resolution of urge symptoms following the TVT operation [22] . Further symptom improvement can be achieved with additional anticholinergic medication [22] .…”

Tension-free vaginal tape-Abbrevo procedure for female stress urinary incontinence: a prospective analysis over 22 months

“…(3) The median erosion after transobturator sling was reported to be 2.4% (range 0%-5.9%). (19) Previous studies have also reported mesh erosion ranging from 0% to 7.3%, (17,18) and the median postoperative groin or thigh pain at six months following transobturator tape was reported to be 0.9% (range 0.6%-5.1%). (17) Persistence of groin pain beyond the immediate postoperative period is a concern in TVT-O.…”

“…(19) Previous studies have also reported mesh erosion ranging from 0% to 7.3%, (17,18) and the median postoperative groin or thigh pain at six months following transobturator tape was reported to be 0.9% (range 0.6%-5.1%). (17) Persistence of groin pain beyond the immediate postoperative period is a concern in TVT-O. (6) In a retrospective study on TVT-O at our own centre involving 419 patients, groin pain was found to have persisted for up to six months in 3.6% of patients.…”

“…(17) The cure for the urge component has shown variable results, but less so than the stress component. The addition of anticholinergic medications enhances the incontinence cure rate in women with mixed incontinence.…”

Is It Possible to Predict Urodynamic Stress Urinary Incontinence in Women with Minimal Diagnostic Evaluation?

“…The remaining patients (11.4%) had uSUI with DO and normal urodynamics. Although uSUI with DO is a challenging condition when planning surgical management for a patient with SUI, many studies have shown that surgical procedures for SUI are safe and effective in the setting of preoperative DO [16,17,18,19]. …”