Experience of tension-free vaginal tape for the treatment of stress incontinence in females with neuropathic bladders

Abstract

Study design: Retrospective. Objective: To evaluate the safety and e cacy of the tension-free vaginal tape (TVT) for the treatment of stress incontinence in females with neuropathic bladders. Setting: London Spinal Injuries Unit, Stanmore & Institute of Urology, London, UK. Methods: Twelve women (mean age 53.3 years; range 41 ± 80 years) with neuropathic bladder dysfunction and stress urinary incontinence were treated with tension-free vaginal tape (TVT) between November 1997 and December 2000. The group consisted of women with: (i) traumatic spinal cord injuries (n=3); (ii) post lumbar spinal surgery (n=6); (iii) spinal stenosis (n=3). Four of the 12 patients had previously failed surgery for stress incontinence. All patients underwent pre-and post-TVT evaluation with video-urodynamic studies. Results: Mean follow-up was 27.1 months (range 17 ± 54 months). Three patients were voiding spontaneously (stress voiding) before surgery and continued to do so post-operatively. The remaining 9 were performing clean intermittent self-catheterisation before the insertion of TVT and continued to do so after the surgery. At follow up 10 patients (83.3%) were dry. The procedure failed in one patient and the other complained of mild leakage, but she reported a decrease in the number of pads used. One patient developed detrusor hyperre¯exia on postoperative video-urodynamics but there was no evidence of stress incontinence. One patient had a bladder perforation on insertion of TVT, managed successfully with extended use of a urethral catheter post-operatively. Three patients developed post-operative urinary tract infection successfully treated with oral antibiotics. Conclusions: Tension-free vaginal tape insertion is minimally invasive, safe and e ective for the treatment of stress incontinence in females with bladder neuropathy with intrinsic sphincter de®ciency. Previous surgery for incontinence did not a ect post-operative complications or outcome.

Long-term outcome of transobturator tape (TOT) for treatment of stress urinary incontinence in females with neuropathic bladders

“…Our results also compare favourably to previously reported success rates with tension-free vaginal tape, 4,5,15,16 with success rates at least as great with longer follow-up in our study. Furthermore, our results are comparable to those achieved in the general population undergoing TOT surgery.…”

“…4,5 This showed success comparable to non-neuropaths in both short and long term with few complications. The aim of this study was to present the first series of long-term safety and efficacy outcomes of placement of mid-urethral synthetic transobturator tapes (TOT) in patients with urodynamically confirmed SUI and NBD due to SCI.…”

“…Following Ulmsten's original description 3 in 1996 of a synthetic polypropylene tension-free vaginal tape placed at a mid-urethral level in retropubic fashion, our unit was the first to study the success of this procedure in neuropathic patients. 4,5 This showed success comparable to non-neuropaths in both short and long term with few complications. The aim of this study was to present the first series of long-term safety and efficacy outcomes of placement of mid-urethral synthetic transobturator tapes (TOT) in patients with urodynamically confirmed SUI and NBD due to SCI.…”

A retrospective study on female urological surgeries over the 10 years following spinal cord lesion

“…All four patients (two with SS-SCL and two with IS-SCL), previously treated with bulking agents, underwent the TVT procedure, when SUI occurred again after a second sphincter injection. 8,9 The only patient with IS-SCL who previously emptied her bladder spontaneously started AIC regimen after TVT surgery. A reduction of around 90% in SUI compared with baseline was maintained up to the final follow-up at around 6 years.…”

“…This result confirms previous positive findings in literature; therefore, TVT surgery should be part of the neuro-urologist's surgical armamentarium. 8,9 It was worth saying that at the time of patient inclusion in the studies, literature had not reported any data concerning, for example, the efficacy/safety of repetitive use of BoNT-A on SCL patients for NOB who were unresponsive to antimuscarinics or the use of SNM on subjects with SCL suffering from N-LUTD.…”