TVT-O effective in long term
medwireNews: Transvaginal tension-free vaginal tape–obturator (TVT–O) results in high long-term efficacy rates and sustained improvements in quality of life for women with stress urinary incontinence (SUI), show the results of the longest follow-up study of the procedure to date.
The retrospective analysis of 124 women found that, after a median of 90.3 months, 81.5% were cured based on the results of a cough stress test, and 83.1% based on responses to the International Consultation on Incontinence Questionnaire for Evaluating Female Lower Urinary tract Symptoms.
The team, from the University of Athens in Greece, found that the risk for subjective failure was independently associated with undergoing concomitant vaginal hysterectomy and having a higher degree of prolapse. Vaginal hysterectomy was associated with a 3.0-fold increase in the odds for subjective failure, while an increase in the degree apical compartment (point C) prolapse was associated with a 1.2-fold increased odds.
And, on univariate analysis, vaginal hysterectomy was the only factor significantly associated with objective failure, raising the odds by 4.4-fold.
Stavros Athanasiou and colleagues note that this is consistent with previous findings of an increased risk for recurrent SUI and a higher likelihood of subjective rather than objective failure in women undergoing prolapse repair surgery.
The team also reports that quality of life was meaningfully improved following the procedure, with significant changes in all domains of the King’s Health Questionnaire. Importantly, these changes were greater than the minimal important clinical difference (reduction of at least 5 points for each domain).
No patients experienced any major perioperative complications, while only two patients experienced major postoperative complications, including voiding difficulties requiring tape division and vaginal erosion. The most common complication was de novo urgency, reported by 7% of women; however, the authors suggest these symptoms could be age-related, given that the mean age of the cohort was 61 years.
Athanasiou and colleagues conclude that their study, published in the International Urogynecology Journal, supports the long-term efficacy of the procedure and “adds valuable information for preoperative counseling of women opting to undergo a TVT-O with concomitant [anterior and posterior pelvic floor repair] surgery.”
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter