THE TENSION FREE VAGINAL TAPE PROCEDURE IN WOMEN WITH STRESS URINARY INCONTINENCE DUE TO INTRINSIC SPHINCTER DEFICIENCY WITHOUT URETHRAL HYPERMOBILITY

C. LaSala, MD, L. DeVita, MD, J. Clemons, MD


   Objective: To estimate the success rate of the tension-free vaginal tape (TVT®) procedure in women diagnosed with stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD) and no urethral hypermobility.

   Methods: A retrospective analysis of 44 women who underwent the TVT procedure for the diagnosis of SUI, with ISD and no urethral hypermobility, was performed. ISD was defined as a maximum urethral closure pressure (MUCP) < 25 cm H2O or valsalva leak point pressure (VLPP) < 60 cm H2O. Urethral hypermobility was defined as a maximal deflection of the urethra during valsalva >30 degrees from the horizontal. All patients had pre-operative history and physical examination including Q-tip test and complex urodynamic testing. Outcome measurements were done at 4, 12, and 18 months post-operatively; these included subjective cure of SUI (no leakage at all with any stress activity), objective assessment of cure as a negative cough stress test with 150 cc bladder volume, and de novo symptoms of urge incontinence. Complications included intra-operative cystotomy, post-operative urinary tract infection (UTI) and urinary retention (post-void residual volumes (PVR) greater than 125 cc! for more than 48 hours.) Patients were divided into two groups: Group 1 were those who were objectively cured of SUI, and Group 2 were those who were not objectively cured of SUI. Group 1 and Group 2 were compared with respect to age, MUCP, VLPP and previous pelvic surgery in order to identify risk factors for failure. Two-tailed t-test was used for statistical analysis.

   Results: 35 women underwent TVT alone and 9 underwent TVT with concomitant pelvic surgery. The mean length of follow-up was 14 months (range 6-24 months.) At 4 months, 37 of 44 women (84%) were objectively cured of SUI. At 12 months 28 of 35 women (80%) were objectively cured. All failures were recognized within the first 4 months. Of the 44 women, 6 (14%) developed de novo urge incontinence. In addition, 11 women (25%) had urinary retention, 7 women had a UTI and there were 6 trocar-related cystotomies (14%.) The 7 women in Group 2 (not cured) had lower pre-operative MUCP values than the 37 women in Group 1(cured): mean MUCP 13 cm H2O vs. 24 cm H2O, p=0.005. There were no differences with respect to age, VLPP or previous pelvic surgery.

   Conclusion: For women with SUI due to ISD and no urethral hypermobility, the TVT is a moderately successful therapeutic option. Women with MUCP less than 14 cm H2O are more likely to fail.

   Key Words: Tension Free Vaginal Tape, Intrinsic Sphincter Deficiency