Paper 25: Outcomes of TVT Procedures Performed in Patients With Stress Urinary Incontinence Secondary to Intrinsic Sphincter Deficiency or Urethral Hypermobility

Abstract

OBJECTIVE: With the increasing use of Tension-Free Vaginal Tape (TVT) to treat urinary incontinence, very little evidence exists to advocate its use in patients with sphincter deficiency. Our goal is to evaluate the efficacy of TVT procedures for stress urinary incontinence in patients with intrinsic sphincter deficiency (ISD) versus those with urethral hypermobility by comparing preoperative and postoperative Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ) scores. METHODS: A chart review was done of all patients between 1999 and 2003 who had completed preoperative UDI and IIQ questionnaires and had preoperative urodynamic testing prior to undergoing a TVT procedure for stress incontinence. The difference in pre- and postoperative UDI and IIQ scores were compared between the 2 groups along with the difference in UDI subscales. ISD was defined as an Ucp ≤ 20 and urethral hypermobility as a ≥ 30° change in the urethral angle with Valsalva. Statistical calculations were performed using Stata 6.0 (Stata Corporation, TX). In the analysis, Pearson Chi Square was used for the categorical variables and a linear regression for the numerical variables. RESULTS: Of the eligible 109 patients, 90 completed the postoperative questionnaires between a 12–60 month time interval. There were 32 patients in the ISD group and 58 in the urethral hypermobility group. Demographic and medical data such as gravidity, parity, ethnicity, tobacco use, diabetes, chronic cough, prior incontinence procedure and concomitant procedures were not significant between the 2 groups. Age and hormonal status was statistically significant with the ISD group being older 64.43 versus 55.45 (OR 3.09, CI 1.25–2.75) and postmenopausal (OR 3.81, CI 1.28–11.31). The change in IIQ scores (postoperative-preoperative) means (ISD 5.09 ± 3.93, urethral hypermobility 7.38 ± 5.22) was not statistically significant between the 2 groups. Also a comparison of the mean postoperative IIQ scores was not statistically significant (ISD 2.31 ± 3.59, urethral hypermobility 2.41 ± 4.44). However, the changes in the difference of the total UDI scores and stress subscale were significant (ISD 6.06 ± 3.93, urethral hypermobility 8.52 ± 5.12, P=0.021 and ISD 3.34 ± 1.89, urethral hypermobility 4.57 ± 1.71, P=0.002) respectively with the greater change in the urethral hypermobility group. There was no difference between the changes in urge and void difficulty subscale scores. When isolating the mean postoperative UDI scores between the groups, no significance was obtained (ISD 3.75 ± 3.47, urethral hypermobility 3.64 ± 3.46). CONCLUSION: The TVT is equally effective in treating patients with stress incontinence secondary to intrinsic sphincter deficiency or urethral hypermobility based on the IIQ and UDI. Patients with urethral hypermobility appear to have a greater improvement in their symptoms as compared to the ISD group.