PD10-06 THE TENSION FREE VAGINAL TAPE VERSUS THE PUBOVAGINAL SLINGS FOR WOMEN WITH NEUROGENIC STRESS URINARY INCONTINENCE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction II1 Apr 2015PD10-06 THE TENSION FREE VAGINAL TAPE VERSUS THE PUBOVAGINAL SLINGS FOR WOMEN WITH NEUROGENIC STRESS URINARY INCONTINENCE Ahmed El-Azab and Sherif El-Nashar Ahmed El-AzabAhmed El-Azab More articles by this author and Sherif El-NasharSherif El-Nashar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.946AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are little data in the literature about the use of the minimally invasive midurethral slings (MUS) in women with neurogenic stress incontinence (nSUI) due to spinal pathologies at or below sacral micturition center. We designed this clinical trial to compare the efficacy and safety of TVT and rectus fascia Pubovaginal sling (PVS) in treating SUI in women with LMNL presenting with SUI. METHODS This is a pilot nonrandomized clinical trial including women with SUI associated with pathology at below S2 spinal segment. Women were non randomly assigned into TVT or PVS groups. Failure was defined as leakage of urine during cough test at 250 mL bladder volume. Primary outcome was time to treatment failure based on positive cough stress test. Other outcomes included UDI6 IIQ7 and Urodynamics. Regression models were utilized to adjust for confounders. Time to failure was the endpoint for that outcome and Kaplan Meier curves were used to calculate the cumulative failure rate in each group. RESULTS 40 women were included; 20 TVT and 20 PVS. For primary outcome, 7 out of 40 (17.5%) women had positive cough stress test and were considered treatment failures. 4 (20%) in the TVT group and 3 (15%) in PVS group. The time to treatment failure in TVT group was comparable to the PVS group with an unadjusted hazard ratio of 2.90 (95%CI, 0.61, 15.42, long-rank test P value=0.154). At 2 year, the cumulative objective failure rate was 5.9% in TVT group compared to 0% at the PVS group. At 4 years, cumulative failure rate was 41.8% in TVT group compared to 25.4% in the PVS group. In both groups, there were significant reductions in UDI-6 and the IIQ-7 total scores. IWhile all patients in PVS group had PVR >150 mL after surgery and required CIC, 8 patients (53%) in TVT group had PVR <150 mL and did not require CIC after surgery. Out of the remaining 12 patients in the TVT group, 5 patients were utilizing CIC before surgery. The remaining 7 had De novo increased PVR (PVR>150) and required CIC after surgery. The prevalence of De novo urge urinary incontinence was significantly higher after TVT (30% n=6 women) than after PVS (10%, n=2). Urodynamics 1 year after operation in those patients with De novo urge symptoms reveal low compliance in 2 patients and unstable bladder contractions in 6 patients (4 in TVT and 2 in PVS group). CONCLUSIONS Both PVS and TVT can be used effectively and safely to treat women with nSUI associated with spinal pathology. While postoperative CIC is needed in all patients after PVS, de novo postoperative CIC after TVT can be avoided in 50% of patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e202 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed El-Azab More articles by this author Sherif El-Nashar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...