Tension-Free Vaginal Tape—A Suitable Procedure for Patients With Recurrent Stress Urinary Incontinence

Abstract

In a recent report, the 10-year reoperation rate for stress urinary incontinence (SUI) after primary failure of anti-incontinence surgery was 17%. A tension-free vaginal tape (TVT) procedure has been effective for primary surgical treatment of SUI and long-term results have been promising. A number of studies have investigated repeat surgery with TVT for recurrent SUI but only one—a retrospective study—used a control group. Moreover, the follow-up period after a repeat TVT has been short; there has been only one uncontrolled prospective 4-year study. This prospective follow-up study investigated the use of the TVT procedure in women with recurrent SUI and those with primary SUI with respect to cure rates, complications, and safety. All participants had a TVT—60 in the study group (recurrent SUI)—and 70 in the control group (primary SUI). The initial follow-up was at 2 months after surgery and patients completed a questionnaire 3 years later evaluating the success of the operation and urinary symptoms. At a mean of 8 years (range, 6–10 years), patient records were examined for data on any subsequent visits or additional surgery. The primary outcome measures were subjective cure, complications, and voiding symptoms. The rate of transient postoperative retention was similar in the 2 groups (recurrent SUI, 17% vs. primary SUI, 19%, P = 0.78). No significant difference was found between the groups in the number of complications (recurrent SUI, 20% vs. primary SUI, 13%, P = 0.27). Spontaneous micturition resumed in all patients by the 10th postoperative day. At the 2-month follow-up visit, 85% of the patients in recurrent SUI group and 94% of those in the primary SUI group were free of SUI and completely satisfied with the outcome (P = 0.096). These data were almost identical at 3 years. Major complications following surgery were rare. At 2 months, 22% of the recurrent SUI patients and 19% of the primary SUI patients had de novo urge symptoms (P = NS); at 3 years, the rate of voiding difficulties was 17% in the primary SUI group and increased to 33% in the recurrent SUI group (difference between groups, P = 0.037). Subjective voiding dysfunction (feeling of incomplete emptying with or without recurrent urinary tract infections) was reported by 5 patients (8.3%) in the recurrent SUI group and in 17 patients (24%) in the primary SUI group at 3 years after the operation (P = 0.022). These findings suggest that TVT is safe and effective when performed for primary or recurrent SUI. There are no apparent differences in cure and complication rates after TVT between patients with and without previous SUI surgery.