Clinical Outcome of Tension-Free Vaginal Tape Procedure for Stress Urinary Incontinence Without Preoperative Urethral Hypermobility

摘要

Objective: To determine the effectiveness of tension-free vaginal tape (TVT) in cases of urodynamic stress incontinence, with or without intrinsic sphincter deficiency, associated with a nonhypermobile urethra. Methods: The medical records of consecutive patients who underwent TVT as an isolated procedure during a 32-month period were subject to retrospective review. Preoperative physical examination findings, urodynamic results, and cotton swab test values were recorded. A nonhypermobye (fixed) urethra was defined as a maximum straining angle less than 30°. Patients had TVT performed under local anesthesia with intravenous sedation. Operations were considered successful if the patients were free of stress incontinence by both subjective and objective criteria. Categorical data were compared using the Fisher exact test. The median values of continuous data were compared using the Wilcoxon rank sum test. Results: One hundred fifty-three patients were included, of whom 139 had urethral hypermobility and 14 did not. Median follow-up was 6 months (range, 0.5-26) in the hypermobile patients and 6 months (range, 1.5-17 months) in the nonhypermobile patients. The success rate of TVT was 92% (137/149) in the patients with urethral hypermobility and 79% (11/14) in the nonhypermobile patients (A = -13%; 95% confidence interval, -35, 8). Conclusions: The success rates of TVT in the presence or absence of preoperative urethral hypermobility appear to be comparable. This result includes the subset of patients with intrinsic sphincter deficiency. TVT may be a viable option for the treatment of stress incontinence in patients with a nonhypermobile urethra.