Tension-free vaginal tape (TVT) and colposuspension have similar long-term efficacy for
treating primary urodynamic stress incontinence, according to recent study findings presented at the International Continence Society annual meeting in Christchurch, New Zealand.
Karen L. Ward, MD, and Paul Hilton, MD, of The Royal Victoria Infirmary in Newcastle upon Tyne in the United Kingdom, based their findings on 72 TVT-treated and 49 colposuspension-treated women who had full subjective and objective five-year follow-up data available. These patients were part of an original group of 344 women with urodynamic stress incontinence randomly assigned to treatment with either TVT (175 patients) or colposuspension (169 patients). The primary outcome measure was cure of stress incontinence as demonstrated by a negative one-hour pad test.
Investigators recorded a negative one-hour pad test for 58 (81%) women in the TVT group and for 44 (90%) in the colposuspension group, a non-significant difference. Additionally, 39% of the TVT group and 46% of the colposuspension group reported no leakage under any circumstances five years after surgery. The percentage reporting cure of stress leakage was 63% and 70% for the TVT and colposuspension groups, respectively.
“Although we have not demonstrated a difference between the procedures for cure of stress incontinence, we cannot be certain that a difference does not exist from this data,” the authors observed.
Overall, 91% and 90% of the TVT and colposuspension groups, respectively, considered themselves satisfied or very satisfied with the results of their surgery at five years. The groups had similar quality-of-life parameters as measured by the SF-36 health status questionnaire.
During follow-up, four TVT patients and five colposuspension patients underwent re-operation for stress incontinence. Moreover, 1.8% of women in the TVT group had surgery for prolapse compared with 7.5% of women in the colposuspension group, a significant difference. Vault and posterior vaginal wall prolapse occurred more frequently following colposuspension, a finding consistent with previous case series.
“The effect of both procedures on cure of incontinence and improvement in quality of life and sexual health is maintained in the long term,” the authors concluded.
They noted that the impact of their study is limited by the high number of post-randomization dropouts before surgery in the colposuspension group (23 vs. 5 in the TVT group) and after surgery in both groups.
The study was one of several presented at the conference that examined the efficacy of TVT. Researchers from Montreal led by Jacque Corcos, MD, reported that elderly women with stress urinary incontinence (SUI) experience a significant improvement in quality of life by undergoing immediate TVT surgery compared with waiting for that same surgery despite age- and technique-related potential morbidities. The study compared 31 women who underwent immediate TVT surgery with 27 who did not (controls). The researchers evaluated patients with the Urinary Incontinence Quality of Life (I-QOL) scale, the Patient Satisfaction questionnaire, and the Urinary Problems self-assessment tool. The I-QOL questionnaire consists of 22 items, each answered on a 1-5 scale for a maximum of score of 110. The Patient Satisfaction questionnaire allows patients to grade their degree of satisfaction regarding incontinence on a scale of 0-10. For both of these scales, the higher the score, the better the outcome. The Urinary Problems tool measures patients’ burden of urinary problems. It has 19 questions, each answered on a scale of 0-2. The lower the score, the better the outcome.
Six months after randomization, the I-QOL score was 96.5 for TVT patients and 61.6 for controls. The Patient Satisfaction scores were 8.0 and 2.0 respectively, and Urinary Problems scores were 4.5 and 11.6. The complication rate observed in the surgery group was similar to those observed in younger women who have undergone TVT surgery. The investigators concluded that invasive surgical treatment of SUI in elderly women is better than no treatment despite age-associated risks.
In another presentation, Italian investigators reported that trans-obturator tape (TOT) is as effective as TVT for SUI in women, with minimal complications at a mean follow-up of 24 months. Their finding is based on a study of 116 women with SUI, of whom 55 were randomized to TVT and 61 to TOT. Objectively, TOT was successful in 59 of 61 patients (97%) and TVT was successful in 52 of 55 patients (94.5%), the researchers reported. The operating time was significantly shorter for the TOT arm (23 vs. 31 minutes).