Long‐term outcome of tension‐free vaginal tape for treating stress incontinence in women with neuropathic bladders

Abstract

questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTSThe mean (range) follow-up was 10 (8.5-12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/ day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONSIn women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good longterm outcomes. KEYWORDSneuropathic bladder, stress incontinence, tension free vaginal tape Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODSTwelve women (mean age 53.3 years, range 41-80) with neuropathic bladder dysfunction and SUI confirmed by videocystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-

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.…”