TENSION-FREE VAGINAL TAPE PROCEDURE: IS EFFICACY INFLUENCED BY SIMULTANEOUS VAGINAL HYSTERECTOMY?

M.P. Gleeson MD, S. Hatangadi MD, V.Fodera MS, M. Mokrzycki MD.

   OBJECTIVE: To investigate if the efficacy of the tension-free vaginal tape procedure for the treatment of stress urinary incontinence is influenced by combining it with vaginal hysterectomy as compared to patients who have had previous hysterectomy.

   METHODS: The pubovaginal sling utilizing tension-free vaginal tape (TVT) has, over the past several years, become one of the most popularized procedures for the treatment of stress urinary incontinence. While the efficacy of the TVT has been demonstrated alone as compared to other vaginal as well as abdominal procedures for the treatment of stress urinary incontinence, there has been little investigation as to whether efficacy is altered in any way by combining the TVT procedure with vaginal hysterectomy as compared to patients with previous hysterectomy. We performed a retrospective cohort study combining chart review with phone interviews on 113 patients who had a TVT performed at our institution from Jan 1, 2000 to Dec 31, 2001. Of these patients, 38 had TVT alone, and of those, 12 had previous hysterectomy. The remaining 75 had TVT combined with other procedures, and of these, 43 had a vaginal hysterectomy. The majority of these also had anterior-posterior repair !
with sacrospineous ligament fixation performed as well. These numbers are a reflection the common population of mostly referrals to this urogynecology center. Efficacy was then compared between these two groups, as defined as continence of urine at 6 months post-op, which was accessed by a standard Quality of Life form.

   RESULTS: Complications were few between both groups, the most common being bladder cystotomy (a known complication of TVT). This occurred in no cases in the group of TVT after hysterectomy alone, and in only 5% of TVT with hysterectomy (p = .23, not sig). Efficacy was also similar comparing the two groups. This was 92% in the TVT after hysterectomy alone group, compared to 86% in the TVT with hysterectomy group ( p = 0.31, not sig).

   CONCLUSION: Combining TVT with vaginal hysterectomy does not appear to increase complication rates, or affect efficacy as determined by patient satisfaction, in comparison to TVT alone in women with previous hysterectomy. Additionally, the TVT appears to be an efficacious treatment for stress urinary incontinence.

   KEYWORDS: Pubovaginal Sling, Tension-Free Vaginal Tape, Stress Urinary Incontinence.