The Importance of Monitoring a Woman's Response to Physical Therapy Intervention in a Patient With Tension-Free Vaginal Tape-Obturator Sling Failure

Abstract

Background: Urinary incontinence is a common chronic health problem among women. Because physical therapists are likely to see patients postoperatively, therapists may play a role in screening for postoperative complications. The purpose of this case report was to demonstrate the importance of carefully monitoring a woman's response to physical therapy (PT) intervention post–tension-free vaginal tape-obturator sling procedure whose persistent symptoms were due to sling failure. Study Design: This is a PT case report that examined patient outcomes and response to PT interventions to determine appropriate referral to a urogynecologist. Case Description: A 62-year-old female patient presented with recurrence of urinary urgency, frequency, and leakage 9 months status post-tension-free vaginal tape-obturator sling surgery. The patient was seen for 8 visits over a 12-week period. Interventions included biofeedback, pelvic floor exercises and home program, instruction in “the Knack,” extracorporeal magnetic treatment, and bladder retraining. Outcomes: Although the patient's score on the Urogenital Distress Inventory Short Form 6 improved from 62.5 to 33.3, analysis of the individual questions demonstrated mixed improvement. The patient's Pelvic Floor Impact Questionnaire–Short Form 7 urine/bladder score worsened from 61.9 to 66.7. Bladder diary outcomes were mixed. She was referred to her urogynecologist because of mixed outcomes combined with failure to achieve all long-term goals within 8 treatment sessions. Subsequent urodynamic testing revealed sling failure. Discussion: This case report demonstrated the importance of carefully monitoring a woman's response to PT intervention post–tension-free vaginal tape-obturator sling procedure whose persistent symptoms were due to sling failure.