THE EFFECT OF THE TVT (TENSION-FREE VAGINAL TAPE) ON URGENCY AND URGE INCONTINENCE

 Jeffrey L. Segal MD, Brett Vassallo MD, Steven Kleeman MD, William Silva MD, Mickey Karram MD

   Objective: The tension free vaginal tape (TVT), a suburethral sling used for the treatment of stress urinary incontinence, can result in worsening urgency or the development of de novo urge incontinence. The objective is to determine risk factors for the development or worsening of postoperative urge incontinence following a TVT.

   Materials and Methods: A retrospective chart review was done on all patients who underwent a TVT alone from November 1998 to June 2002. Those who had concomitant procedures done at the time of their TVT or those with follow-up times of less than 6 weeks were excluded. Preoperative symptoms of urge incontinence were assessed subjectively through questioning in the office and quality of life questionaires, and objectively, by simple office cystometry and multichannel urodynamics. Postoperatively, urge incontinence was presumed if a patient required anticholinergics at least 6 weeks following surgery.

   Results: 262 patients were excluded due to concomitant reconstructive procedures and an additional 11 patients were excluded due to follow-up of less than 6 weeks. Of the 61 remaining patients, 23 presented with symptoms of stress urinary incontinence, 4 with symptoms of urge incontinence, and 34 with symptoms of mixed urinary incontinence. Although only 4 patients (3 with mixed and 1 with urge symptoms) were noted to have preoperative detrusor contractions either on simple filling cystometry or multichannel urodynamics, 26 patients were treated preoperatively with anticholinergics because of symptoms of urge incontinence. Posteroperatively, 44 patients were without urgency symptoms and 17 had symptoms of urge incontinence requiring anticholinergics. Of these 17 patients, 14 had mixed symptoms, 1 had urge symptoms and 2 had stress symptoms of incontinence preoperatively. Additionally, 11 had been given anticholinergics preoperatively and 2 were observed to have detruso! r contractions preoperatively.

   Conclusions: It is unlikely that patients who present with purely stress symptoms will require postoperative anticholinergics following a TVT. Preoperative symptoms of mixed urinary incontinence or the preoperative need for anticholinergic medications may be risk factors for the development of postoperative urge incontinence.

   Key Words: TVT, urge incontinence