Tension-Free Vaginal Tape for the Treatment of Recurrent Stress Incontinence
Drs. C. Rardin, P. Rosenblatt, N. Kohli
Boston Urogynecology Associates
Boston, Massachusetts

Objective:   To evaluate the outcomes of Tension-free Vaginal Tape (TVT) in the treatment of recurrent versus primary genuine stress urinary incontinence (GSUI).
Methods: 170 women were treated with TVT for GSUI over a 2-year period (127 for primary and 43 for recurrent GSUI).  Concurrent surgical repairs were performed as required.  The endpoints evaluated included subjective cure or improvement at six weeks, and at standardized followup office visits.  Office and hospital records were reviewed to determine differences in patient characteristics, intraoperative findings, and surgical outcomes.
Results: Women with recurrent GSUI were slightly older (mean age 63 vs. 56 years) than those without, and were more likely to have intrinsic sphincter deficiency (79% vs. 49%).  Rates of concurrent pelvic repairs were similar (51% vs. 49%).  Median followup was 38 weeks (range: 8-124 weeks).  Cure rates among patients with recurrent vs. primary GSUI were 77% and 84%, respectively.  Eighty-six percent of women with recurrent GSUI reported cure or significant improvement, compared with 93% of patients with primary GSUI.  Complication rates were similarly low in both groups (5% vs. 8% for recurrent and primary GSUI, respectively).  Postoperative voiding dysfunction occurred at a lower rate among women with recurrent GSUI (7% vs. 17%).
Conclusion: TVT is a highly effective treatment among patients with recurrent stress incontinence, and is not associated with increased risk of complication or voiding dysfunction.