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Tension-free Vaginal Tape at a Medium Sized Hospital in Sweden: Short- and Long-term Results in Different Patient Groups
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In the years 1995 to 2001, 970 women with urinary incontinence underwent surgery with tension-free vaginal tape (TVT) at the Department of Obstetrics and Gynecology, Falun Hospital. In 2002 the charts of all these women were reviewed and a questionnaire was sent in 2004. 760 women (78,4%) answered the questions. The mean time since surgery was 5.7 years. The mean age at surgery was 58.7 years. Of all patients, 580 had pure stress urinary incontinence (SUI) and 112 had mixed urinary incontinence (MUI) prior to surgery. Of the women with SUI, 85 % were subjectively and persistently cured. Of the women with MUI, 60 % were subjectively cured up to 3 years after the TVT operation.  However this figure declined to 30 % among women operated on 6-8 years previously. The increasing incontinence was due to urgency symptoms and urge urinary incontinence (UUI).The IIQ-7 and UDI-6 questionnaires were used for measuring quality of life. The women showed dramatic improvement after TVT surgery irrespective of time since surgery. Women with chronic diseases also had relative improvement in QOL scores. Sixty-seven of the women with pure SUI preoperatively (14.5%) reported persistent de novo urgency symptoms postoperatively and 51 of the women also had UUI. Old age, history of cesarean section, increasing parity and BMI were risk factors for developing de novo urgency after TVT procedure. Among women ≥ 75 years 55.7% reported cure after TVT, compared to 79.7% of women < 60 years. The overall cure rate in the very overweight women (BMI ≥ 35) was 52.1%, compared to 81.2% in women of normal weight (BMI < 25).

Conclusions. The subjective results after TVT surgery for SUI are very good even after 8 years. Short-term effect of TVT on MUI is acceptable, but declines after 3 years. Improvements in measures of quality of life after TVT surgery are dramatic and persistent in both the SUI and MUI groups. Women who developed de novo urgency symptoms after TVT surgery reported poorer quality of life. The TVT procedure is simple and safe, but the results in the oldest or most overweight women are not as good as in the younger or normal weight women.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2010. , p. 59
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 547
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:uu:diva-121550ISBN: 978-91-554-7766-0 (print)OAI: oai:DiVA.org:uu-121550DiVA, id: diva2:305699
Public defence
2010-06-08, Rosénsalen, Akademiska sjukhuset, Ing 96, Kvinnokliniken, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-04-26 Created: 2010-03-25 Last updated: 2010-04-26Bibliographically approved
List of papers
1. Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence.
Open this publication in new window or tab >>Long-term results with tension-free vaginal tape on mixed and stress urinary incontinence.
2005 (English)In: Obstet Gynecol, ISSN 0029-7844, Vol. 106, no 1, p. 38-43Article in journal (Refereed) Published
Keywords
Aged, Female, Follow-Up Studies, Humans, Logistic Models, Middle Aged, Multivariate Analysis, Patient Satisfaction, Probability, Questionnaires, Risk Assessment, Severity of Illness Index, Surgical Mesh, Time Factors, Treatment Outcome, Urinary Incontinence/etiology/pathology/surgery, Urinary Incontinence; Stress/etiology/pathology/*surgery, Urodynamics, Urologic Surgical Procedures/*methods, Uterine Prolapse/diagnosis/*surgery
Identifiers
urn:nbn:se:uu:diva-75751 (URN)15994615 (PubMedID)
Available from: 2006-08-09 Created: 2006-08-09 Last updated: 2011-01-11
2. Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence-A long-term follow-up
Open this publication in new window or tab >>Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence-A long-term follow-up
2007 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 132, no 1, p. 121-125Article in journal (Refereed) Published
Abstract [en]

Background

To determine risk factors for the appearance of de novo urgency symptoms, and subsequent accompanying problems, after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence.

Method

A structured preoperative analysis of the incontinence symptoms was made. A mailed questionnaire was distributed to 970 women that underwent the TVT procedure between 1995 and 2001. Average follow-up was 5.2 years (range 2–8 years). The questionnaire included specific questions on current urinary symptoms and incontinence. The disease-specific quality of life instruments IIQ-7 and UDI-6 were used to compare women with, and those without de novo urgency.

Results

Seven hundred and sixty women (78.3%) responded and 463 of those were identified as genuine stress incontinence preoperatively. De novo urgency occurred in 67 (14.5%) of the women. The frequency was similar irrespective of duration since the TVT procedure. The women that reported de novo urgency symptoms were compared with those without symptoms. Risk factors for occurrence of de novo urgency symptoms were older age (64.7 years versus 60.9 years; p=0.01), parity (2.6 versus 2.3; p=0.05), history of cesarean section (9.5% versus 2.5%; odds ratio 5.4), and history of recurrent urinary infections (29.7% versus 18.8%; odds ratio 1.6, but non-significant. De novo urgency had a severe impact on quality of life, as compared to the remaining study population.

Conclusion

Old age, parity and history of cesarean section were risk factors for de novo urgency after TVT surgery. Postoperative de novo urgency symptoms are as bothersome for the patient as the preoperative stress urinary incontinence.

Keywords
Female urinary incontinence, De novo urgency, Tension-free vaginal tape, Prognosis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-11084 (URN)10.1016/j.ejogrb.2006.04.012 (DOI)16815624 (PubMedID)
Available from: 2007-05-23 Created: 2007-05-23 Last updated: 2017-12-11Bibliographically approved
3. Quality of life after tension-free vaginal tape surgery for female stress incontinence.
Open this publication in new window or tab >>Quality of life after tension-free vaginal tape surgery for female stress incontinence.
2006 (English)In: Scand J Urol Nephrol, ISSN 0036-5599, Vol. 40, no 2, p. 131-7Article in journal (Refereed) Published
Keywords
Adult, Aged, Aged; 80 and over, Female, Follow-Up Studies, Gynecologic Surgical Procedures/*rehabilitation, Health Status, Humans, Mental Health, Middle Aged, Quality of Life, Retrospective Studies, Time Factors, Urinary Incontinence; Stress/physiopathology/psychology/*surgery, Vagina/*surgery
Identifiers
urn:nbn:se:uu:diva-24578 (URN)16608811 (PubMedID)
Available from: 2007-02-06 Created: 2007-02-06 Last updated: 2011-01-11
4. The very obese woman and the very old woman: Tension-free vaginal tape for the treatment of stress urinary incontinence
Open this publication in new window or tab >>The very obese woman and the very old woman: Tension-free vaginal tape for the treatment of stress urinary incontinence
2007 (English)In: International Urogynecology Journal, ISSN 0937-3462, E-ISSN 1433-3023, Vol. 18, no 4, p. 423-429Article in journal (Refereed) Published
Abstract [en]

A mailed questionnaire was sent to 970 consecutive women who underwent a tension-free vaginal tape (TVT) procedure between 1995 and 2001 at the Department of Obstetrics and Gynecology in Falun Hospital. Seven hundred and sixty (78.4%) women responded. The outcome was compared between women older than 75 years (n=113) and younger women, and between women with a body mass index (BMI) above 35 (n=61) and those who had normal weight. Mean follow-up was 5.7 years. Thirty-six elderly women and one of the obese women were deceased at the long-term follow-up. TVT was easy to perform and was a safe procedure for women in all groups. There was a sharp decrease in cure rate of any urinary incontinence problems among women aged 75 years or more (55.7%), as compared to those who were younger (79.7%). The cure rate moderately decreased from BMI groups 19–24 to 30–34. BMI ≥35 seemed to be the best explanatory cutoff level. The overall cure rate in women of normal weight was 81.2%, as compared to 52.1% in the very obese. The cure rate for urinary incontinence with tension-free vaginal tape in women above 75 years of age and in women with a BMI above 35 was acceptable, but lower as compared to the remaining study population.

Keywords
Urinary incontinence, Tension-free vaginal tape, Obesity, Aged
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-10385 (URN)10.1007/s00192-006-0162-2 (DOI)000244724400011 ()16868657 (PubMedID)
Available from: 2007-03-21 Created: 2007-03-21 Last updated: 2017-12-11Bibliographically approved

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