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Long‐term follow up of tension free vaginal tape for stress urinary incontinence in females with neuropathic bladder

Abstract

Introduction: We evaluated safety and long‐term efficacy of TVT in treatment of urodynamic stress incontinence (USI) in females with neuropathic bladders. Method: Sixteen incontinent female patients were treated. 11 women were postlumbar spinal surgery and five postspinal cord injury. Four had previously failed surgery for USI. Patient demographics, pre and postoperative clinical and videocystometrogram (VCMG) parameters were recorded. Continence assessment at 6 weeks (voiding diary and pad test), 3 months (VCMG) and yearly follow up was recorded. Results: Mean age was 55 years with mean follow up of 52.7 months (range 12–86). At last follow up 87.5% patients (14/16) were continent. The two failures were due to persistent USI and postoperative detrusor hyperreflexia (DH). DH was pre operatively present in 4, requiring simultaneous intra detrusor botulinum toxin injections in two and anticholinergic medications in rest. Bladder perforation was seen in one and urinary infections in three. Mean pre and postoperative detrusor pressures were 23.8 and 15 cm of water. Two patients continued to use pads (3/day) similar to pre operative cumulative average of three pads/day. Preoperatively 11 patients performed intermittent catheters (SIC), three spontaneous voids (SV) and one combination of the two with one on indwelling urethral catheter (IDUC). One patient each on SV, SIC and IDUC changed to SIC. Conversely one each on SIC and SV changed to combination. Conclusion: TVT is safe, effective long‐term treatment for USI in females with neuropathic bladders. DH needs adequate suppression with regular VCMG follow up. Previous incontinence surgery did not affect complications or outcome.