Outcomes of Tension-Free Vaginal Tape in Women With Intrinsic Sphincter Deficiency With or Without Urethral Hypermobility

Abstract

In Brief Objective: The objective of this study was to evaluate the outcomes of tension-free vaginal tape (TVT) for the treatment of female urodynamic stress incontinence (USI) resulting from intrinsic sphincter deficiency (ISD) in patients with and without urethral hypermobility. Methods: A 2-center cohort study of 175 consecutive women treated with TVT for USI with ISD over a 30-month period was performed. One hundred twenty-four (71%) women had coexisting urethral hypermobility and 51 (29%) had fixed urethrae. Concurrent surgical repairs were performed as required. Outcome data were collected at routine postoperative visits. Office and hospital records were reviewed to determine differences in patient characteristics, intraoperative findings, and surgical outcomes. The study was powered to detect a 20% difference in cure rates between the 2 groups. Results: Women with fixed urethrae were older than those with urethral hypermobility (72.3 versus 61.3 years, P < 0.0001) and were less likely to undergo concurrent anterior colporrhaphy (12% versus 37%, P = 0.0009). They were more likely to undergo concurrent posterior colporrhaphy (43% versus 20%, P = 0.0018). Cure rates among patients with fixed versus hypermobile urethrae were similar (83% and 86%, respectively, P = 0.61). Complication rates were similarly low in both groups (5.9% versus 5.6% for fixed and hypermobile urethrae, respectively). Postoperative voiding dysfunction occurred at similar rates in both groups (P = 0.96). Conclusion: TVT is a highly effective treatment among patients with USI resulting from ISD with comparable cure rates in patients with or without urethral hypermobility. Tension-free vaginal tape is an effective treatment for intrinsic sphincter deficiency, regardless of preoperative urethral mobility (Q-tip) status.