Tension-free Vaginal Tape

Abstract

Many different surgical techniques have been introduced for the treatment of female stress urinary incontinence (SUI). They not only differ with regard to success, but they also have different complication rates. TVT is a relative new minimally invasive procedure and is based on the concept of mid urethral support. The aims of the studies presented in this thesis were to assess: 1 the anatomical complications, its frequency and the influence of risk factors. 2 the pre- and intraoperative factors influencing the success of the TVT. 3 the long-term outcome of TVT in women in whom the TVT procedure was their first incontinence surgery. 4 the outcome after a follow-up of three years of TVT in women with previous incontinence or prolapse surgery. 5 the long-term outcome of TVT on urge incontinence and other forms of irritative bladder symptoms. 6 the outcome with a follow-up of three years of the TVT procedure in women with concomitant pelvic surgery. 7 the prevalence of immediate postoperative and long-term voiding difficulties (VD) after TVT. Between March 2000 and September 2001 women with an indication for a TVT procedure were asked to participate in this study. This was a long term ((3 years follow-up of all patients), multicenter prospective cohort study with 41 hospitals and 54 gynaecologists and urologists participating. RESULTS The original database comprised data from 809 women. 1 TVT is a relative safe procedure, concomitant pelvic surgery can be safely performed. Several risk factors for complications were identified. 2 General anaesthesia and inexperience of the surgeon with the TVT procedure seemed to have a negative effect on the result. Therefore, we believe that the TVT should only be performed by experienced surgeons. 3 This is the largest study which used validated disease specific health-related quality of life (HRQoL) questionnaires to asses the long term outcome of the TVT procedure. This study shows a long-term improvement of the quality of life after a TVT. 4 TVT is a valuable tool for women with recurrent stress urinary incontinence, prior prolapse surgery or both. Therefore, we think the TVT should be recommended for the treatment of recurrent stress urinary incontinence in women with previous incontinence and/or prolapse surgery. 5 This study reports the long term outcome of symptoms of frequency, nocturia, urge incontinence, overactive bladder (OAB), irritative symptoms. These symptoms are often prevalent prior to TVT and often resolve afterwards. Urge incontinence and OAB wet symptoms developed in 11% and 3% respectively and gave less improvement on the quality of life scores. Over all most symptoms resolved significantly more than they developed after TVT, resulting in a better quality of life after TVT. 6 TVT is effective for women without and with concomitant prolapse surgery, after 2 years a difference in UDI & IIQ scores could be identified. 7 Quality of life after TVT is only in part negatively influenced by the existence of VD and women who develop VD, are still significantly improved compared to their preoperative condition. Furthermore in most women the clinical course of developing urinary retention after TVT is mild.