Morbidity of incontinence surgery in women over 70 years old: a retrospective cohort study

Abstract

Objective To compare the success rate and complications after colposuspension and tension-free vaginal tape (TVT) insertion in women aged 70 years or more compared with younger women. Design A retrospective study of patients having surgery between November 2000 and October 2002.Setting A tertiary referral, academic urogynaecology unit in a University teaching hospital.Population Two hundred and twenty-six women having surgical treatment for urinary incontinence.Methods Data on cure/improvement and complications were extracted from the notes. Patients were grouped by age at surgery and the odds ratios (OR) and 95% confidence intervals (CI) for each outcome were calculated. Main outcome measures Subjective cure rate and the incidence of complications by age group.Results One hundred and three patients had colposuspension, 11 (10.7%) aged 70 or more. One hundred and twenty-three patients had TVT insertions, 23 (18.7%) aged 70 or more. The cure rate for each procedure was similar between age groups. After colposuspension, urinary tract infection (UTI; OR 11.33; 95% CI 2.61, 49.28) and long term self-catheterisation (percentage of difference 9.1; 95% CI 3.0, 15.2) were more common in women over 70. After TVT, repeat urodynamics (OR 3.91; 95% CI 1.11, 13.76), recurrent UTI (OR 4.22; 95% CI 1.03, 17.26) and tape division (OR 29.12; 95% CI 3.20, 264.86) were more common in older women. Conclusions Incontinence surgery carries a higher risk of complications in the elderly including UTI and voiding dysfunction. Extended antibiotic prophylaxis and intermittent self-catheterisation training should be offered to elderly women before surgery.

Voiding Dysfunction after the Tension-Free Vaginal Tape Procedure

“…The studies with the focus on surgical management of voiding dysfunction determined a proportion of surgical intervention because of urinary retention from 1.7 to 11% (table 3). Various factors were shown to be associated with postoperative voiding difficulties, including the age of the patient [20,21,22], abnormal preoperative uroflow pattern [20,21,23,24], general anesthesia [23], previous incontinence surgery [21], an inexperienced surgeon [8], recurrent surgery [19], concurrent vault suspension surgery [7], and postoperative urinary tract infection [7]. Other authors do not corroborate these risk factors [10,25].…”

Challenges of Longevity: Safety of Vaginal and Laparoscopic Urogynecological Procedures in Septuagenarians and Older Patients

“…Although fairly consistent in that a comparable anatomical outcome can be achieved, studies seem controversial with regard to postoperative complications. Whereas some showed no differences [16, 17, 25, 26], others had proven that elderly patients suffered significantly from more postoperative complications than the younger ones [18–20, 27]. …”

Patient-reported outcomes after combined surgery for pelvic floor disorders in older compared to younger women

“…To estimate a sample size calculation, based on previous literature we assumed the proportion of subjective SUI success following midurethral slings in older women to be between 55%–77%12, 13 and for younger women to be 92%. 13 On the basis of these estimates, we determined that a sample size of 65 women per group would have 80% power to detect a 20% difference at an alpha =.05.…”