A REPORT OF 5-YEAR OUTCOME OFTVT-SECUR SURGERY FOR WOMEN WITH URODYNAMIC STRESS INCONTINENCE
O. WAN1, S. CHAN 2,R. CHEUNG 3;
1Obstetrics and Gynaecology,The Chinese Univ. of Hong Kong, Hong Kong, Hong Kong, 2ChineseUniv. of Hong Kong, Shatin, Hong Kong, 3Obstetrics &Gynecology, Prince of Wales Hosp., Hong Kong, Hong Kong.
Introduction: Urodynamic stressincontinence (USI) is common in women. Tension free transvaginal tape(TVT) surgery becomes the standard operation for treating USI sinceits introduction in 1995. Newer modification of TVT surgery by singleincision such as TVT-SECUR was marketed and was introduced at thestudy centre since 2007. Although it has been withdrawn from themarket, contrasting results were found in literature and long termoutcome was still limited1.
Objective: Toevaluate the 5-year outcome of TVT-SECUR for women suffering fromurodynamic stress incontinence.
Methods: Patients wereevaluated at baseline for demographic data, urinary symptoms, andphysical examinations. Pre-operative urodynamics study was performedto confirm USI before surgery. There may be concomitant pelvic floorsurgery for pelvic organ prolapse. Urinary symptoms and othercomplain, if any, were reviewed at 12 weeks, then annually till 5years after operation or longer for those with complications or othercomplaints. Physical examination was conducted at each follow-up tolook for mesh erosion. All the medical records of the women who hadTVT-SECUR performed were reviewed to collect the above data. Alldevice-related and procedure-related adverse events arecollected.
Results: There were 60 TVT-SECUR performed forwomen suffering from USI. Among them, 22 (36.7%) had TVT-S done aloneand 38 (63.3%) had TVT-S and concomitant pelvic floor surgeryperformed. The mean age of all women were 59.2 ± 11.0 years andparity was 3.2 ± 1.6. Table 1 showed the demographic detail andpre-operative urinary symptoms. Regarding the long term outcome,there were 45 women completed the 5-years follow-up with 22%loss-to-follow-up rate. For those loss-to-follow-up, all reported tobe well and asymptomatic at their last follow-up (range from 1 yearto 4 years after the operation). The outcome of 5-year follow up wasshown in Table 2. There were 12 women (26.7%) had recurrence ofsymptoms of stress urinary incontinence while 7 women (15.6%)required second continence operation, mainly by TVT-Obturator, mostlydone within 1-2 years after the first continence surgery. There wereno voiding difficulties found in all women Total 5 women were foundto have mesh exposure in the study centre with 1 lose to follow-up 1year after operation. All five of them were symptomatic and hadexposed mesh excised either under local anaesthesia or generalanaesthesia for 1-3 times.
Table 1. Demographic data andpre-operative symptoms
TVT-Salone n = 22
TVT-Sand concomitant surgery n = 38
Table 2. Post-operative outcome at5-year follow up
Allpatients N = 45 (%)
TVT-Salone n = 17 (%)
TVT-Sand concomitant surgery n = 28 (%)
Recurrenceof stress urinary incontinence
Conclusions: By 5 yearsafter TVT-SECUR, 27% of women had recurrence of SUI and 16% requiredsecond operation. Women should be offered other types of TVT withhigher efficacy.
References: Eur J Obstet Gynecol ReprodBiol. 2015;185:151-5.