Tension-Free Vaginal Tape: Over 10 Years Follow-Up

| Urology
Elisabetta Costantini,1 Ester Illiano,1 *Franca Natale2

The authors have declared no conflicts of interest.

EMJ Urol. ;7[1]:36-37. Abstract Review No. AR2.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

This study set out to examine the long-term outcomes of tension-free vaginal tape (TVT) to treat stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (MUI). Women are living longer, which means they live for longer with the effects of any chronic treatments they have had, and thus there is an increasing need to study the long-term outcomes of these treatments. Of particular interest was the evaluation of whether short-term outcomes of TVT could be maintained over a longer period, and a minimum 10-year follow-up was implemented for this. In addition, the researchers were interested in what long-term complications would present, both in terms of anatomic and functional complications, as well as what the larger challenges were for patients over this period.

At a mean follow-up of 139 months, 73% of the cohort was cured; this figure was lower than results in the literature for short and medium-term follow-up, but nonetheless positive. No anatomical complications were encountered, but a statistically significant increase in functional complications was seen: urgency increased from 29.6% to 35.9%, urgency urinary incontinence increased from 31.2% to 34.3%, de novo urgency occurred in 6.2% of cases, and de novo voiding symptoms appeared in 4.5% of patients.

These results plus data on quality of life show that women who undergo TVT can expect the improvement obtained from their operation to continue in the long-term. There is, however, an increase in functional complications compared to the short-term. One problem in evaluating results of this kind is that it is difficult to separate a deterioration due to the surgery not lasting over time from symptoms due to new pathologies or simply due to ageing. Studies are needed to enable the identification of bias influencing complications in the long-term.

This is not the first study on the long-term outcomes of TVT,1-3 but it is the first to include both patients with pure SUI and those with stress-predominant MUI (i.e., SUI+overactive bladder [OAB]). The reason these patients were included in this study is that there are twice as many SUI patients with OAB as without.4 These results overall are not as positive as the previous studies on pure SUI, but this is explained, at least in part, by the inclusion of patients with SUI+OAB. Studies are needed to compare long-term outcomes of patients with SUI with and without OAB.

Nilsson CG et al. Seventeen years' follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J. 2013;24(8):1265-9. Braga A et al. Tension-free vaginal tape for treatment of pure urodynamic stress urinary incontinence: Efficacy and adverse effects at 17-year follow-up. BJU Int. 2018;122(1):113-7. Zhang Y et al. Tension-free vaginal tape for the treatment of stress urinary incontinence: A 13-year prospective follow-up. J Minim Invasive Gynecol. 2018. pii: S1553-4650(18)30425-4. Serati M et al. Urodynamics useless before surgery for female stress urinary incontinence: Are you sure? Results from a multicenter single nation database. Neurourol Urodyn. 2016;35(7):809-12.