The tension free vaginal tape operation for women with mixed incontinence: Do preoperative variables predict the outcome?

Abstract

Aims: The aims of our study were (1) to investigate subjective and objective outcomes after tension free vaginal tape (TVT) operations in mixed incontinent women, (2) to detect if preoperative subjective and objective variables predict the outcome, and (3) to evaluate whether the surgical outcome is di¡erent for women who preoperatively ¢nd stress incontinence, urge incontinence, or urge and stress incontinence equally the predominant bother. Methods: A prospective cohort study was performed on 450 mixed incontinent women. A short-form disease-speci¢c validated questionnaire, 24-hr pad test, standardized stress test, residual urine, and maximum urinary £ow were used before and after a TVT operation. ''Cure'' was de¢ned as a condition where the women were very satis¢ed with the TVT operation and had negative stress-and 24 hr pad tests. Results: Preoperatively 69% had stress incontinence, 7% urge incontinence, and 24% urge and stress incontinence equally as the predominant bother. Cure rates were 80%, 52%, and 60%, respectively, in these groups. Postoperatively 43% of the women had no urge incontinence, while 49% were less, and only 8% were more bothered by urge incontinence. A higher preoperative urge incontinence index was correlated with signi¢cantly higher postoperative bother for all indices and leakage during 24-hr pad test. Conclusions: Mixed incontinent women with predominant stress incontinence had a better cure rate than those with predominant urge incontinence and those who were equally bothered by urge and stress incontinence. This point needs to be addressed when informing mixed incontinent women before a TVT operation. Neurourol. Urodynam. 26: 115^121, 2007. ß 2006

Mixed incontinence: does preoperative urodynamic detrusor overactivity affect postoperative quality of life after pubovaginal sling?

“…Consequently, it is possible that the intensity of urgency symptoms is a confounding factor in our findings. With a larger sample size, we may have confirmed Kulseng-Hanssen's recently published findings that MUI patients with urge predominant symptoms may experience a lower QOL after TVT, compared to MUI patients with stress predominant symptoms (18). A larger sample size may have better discerned the influence of symptom intensity on MUI surgical outcome.…”

Pre‐operative opening detrusor pressure is predictive of detrusor overactivity following TVT in patients with pre‐operative mixed urinary incontinence

“…Their subjective and objective cure rates and quality of life after treatment are reduced compared with women with isolated urodynamic stress incontinence 4,5 and because of this, management of these women remains controversial. Conventional urodynamic studies are routinely employed to detect detrusor overactivity in women with stress urinary incontinence prior to undertaking continence surgery and this is also undertaken as a first-line investigation in women with mixed urinary incontinence.…”

“…It has a cure rate comparable to the traditional 'gold-standard' procedure, the Burch colposuspension. [4][5][6][7] Post-operatively urgency is a complication of continence surgery, [4][5][6][7][8][9] and this risk is increased in women with preoperative detrusor overactivity or urgency in the presence of urge urinary incontinence. 9 A treatment for women diagnosed with urodynamic mixed incontinence prior to continence surgery is to prescribe anti-cholinergic medication and pelvic floor exercises to treat each component and this approach is employed by 73% of surgeons performing colposuspension.…”

Preoperative Factors as Predictors of Outcome of Midurethral Sling in Women with Mixed Urinary Incontinence

“…But on the other hand, when cure was defined as complete dryness, the subjective cure rate dropped to 35.9% at 7 months and 28.4% after 38 months. (Kulseng Hanssen et al, 2007) Another pitfall in the interpretation of these data is the discrepancy between subjective and objective determination of treatment success. Karram and Bhatia reported results in 52 women, 27 of whom underwent surgery (i.e., modified Burch colposuspension procedures).…”

“…Cure rate of MUI is better in a group of women with predominant SUI symptoms in comparison to a group with predominant UUI symptoms. (Kulseng Hanssen et al, 2007) The effect of detrusor overactivity on urodyamics associated with MUI on outcomes is not www.intechopen.com as clear as the majority of studies did not include urodynamically proven MUI. MUI implies a component of detrusor dysfunction that may be motor or sensory and is associated with superimposed urethral sphincteric underactivity.…”