Evaluation of Transobturator Tension-Free Vaginal Tapes in the Surgical Management of Mixed Urinary Incontinence

3-Year Outcomes of a Randomized Controlled Trial

Mohamed Abdel-Fattah*, Laura R. Hopper, Alyaa Mostafa

*Corresponding author for this work

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: We evaluate the clinical effectiveness of transobturator tension-free vaginal tape procedures in the surgical management of mixed urinary incontinence in women at 3-year followup.

Materials and Methods: In this secondary analysis of a prospective, single-blind, randomized controlled trial 83 of 341 women (24%) with mixed urinary incontinence were randomized to undergo an outside-in (Aris (R) transobturator sling system 42) or inside-out (TVT (TM)-O 41) transobturator tension-free vaginal tape procedure. Patients were contacted by postal questionnaire at a minimum of 3 years postoperatively. The primary outcome was the patient reported success rate, defined as very much improved/much improved on the PGI-I (Patient Global Impression of Improvement). Secondary outcomes included improvement in quality of life, impact on preoperative urgency/urgency incontinence and repeat surgical treatment for stress urinary incontinence. Outcomes at 3 years were compared between groups (outside-in vs inside-out) and to 1-year outcomes. Analysis was performed using SPSS (R) version 20 with significance levels set at p = 0.05.

Results: A total of 66 women with mixed urinary incontinence completed the 3-year followup (outside-in 35 vs inside-out 31). In each group 2 women underwent further continence surgery. The patient reported success rate was 73.8% with no significant differences between the groups (OR 1.035, 95% CI 0.342-3.134, p = 0.951). Overall 34 (50.1%) and 26 women (56.5%) reported cure of preoperative urgency and urgency incontinence, respectively, and 52 women (86.7%) had a clinically significant improvement in quality of life (18 points or more in total KHQ [King's Health Questionnaire] score) compared to baseline.

Conclusions: Transobturator tape procedures are associated with a good (73.8%) patient reported success rate at a minimum of 3 years of followup in the surgical management of mixed urinary incontinence in women with predominant stress urinary incontinence symptoms. Nearly half of the women reported cure of urgency/urgency incontinence.

Original languageEnglish
Pages (from-to)114-119
Number of pages6
JournalJournal of Urology
Volume191
Issue number1
Early online date24 Jul 2013
DOIs
Publication statusPublished - Jan 2014

Keywords

  • urinary incontinence
  • suburethral slings
  • urodynamic stress-incontinence
  • sexual function
  • midurethral slings
  • impact
  • women
  • surgery
  • complications
  • urge

Cite this

@article{5f5c290c6c2d437eb3d6dbc5e1445568,
title = "Evaluation of Transobturator Tension-Free Vaginal Tapes in the Surgical Management of Mixed Urinary Incontinence: 3-Year Outcomes of a Randomized Controlled Trial",
abstract = "Purpose: We evaluate the clinical effectiveness of transobturator tension-free vaginal tape procedures in the surgical management of mixed urinary incontinence in women at 3-year followup.Materials and Methods: In this secondary analysis of a prospective, single-blind, randomized controlled trial 83 of 341 women (24{\%}) with mixed urinary incontinence were randomized to undergo an outside-in (Aris (R) transobturator sling system 42) or inside-out (TVT (TM)-O 41) transobturator tension-free vaginal tape procedure. Patients were contacted by postal questionnaire at a minimum of 3 years postoperatively. The primary outcome was the patient reported success rate, defined as very much improved/much improved on the PGI-I (Patient Global Impression of Improvement). Secondary outcomes included improvement in quality of life, impact on preoperative urgency/urgency incontinence and repeat surgical treatment for stress urinary incontinence. Outcomes at 3 years were compared between groups (outside-in vs inside-out) and to 1-year outcomes. Analysis was performed using SPSS (R) version 20 with significance levels set at p = 0.05.Results: A total of 66 women with mixed urinary incontinence completed the 3-year followup (outside-in 35 vs inside-out 31). In each group 2 women underwent further continence surgery. The patient reported success rate was 73.8{\%} with no significant differences between the groups (OR 1.035, 95{\%} CI 0.342-3.134, p = 0.951). Overall 34 (50.1{\%}) and 26 women (56.5{\%}) reported cure of preoperative urgency and urgency incontinence, respectively, and 52 women (86.7{\%}) had a clinically significant improvement in quality of life (18 points or more in total KHQ [King's Health Questionnaire] score) compared to baseline.Conclusions: Transobturator tape procedures are associated with a good (73.8{\%}) patient reported success rate at a minimum of 3 years of followup in the surgical management of mixed urinary incontinence in women with predominant stress urinary incontinence symptoms. Nearly half of the women reported cure of urgency/urgency incontinence.",
keywords = "urinary incontinence, suburethral slings, urodynamic stress-incontinence, sexual function, midurethral slings, impact, women, surgery, complications, urge",
author = "Mohamed Abdel-Fattah and Hopper, {Laura R.} and Alyaa Mostafa",
year = "2014",
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doi = "10.1016/j.juro.2013.07.035",
language = "English",
volume = "191",
pages = "114--119",
journal = "Journal of Urology",
issn = "0022-5347",
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T1 - Evaluation of Transobturator Tension-Free Vaginal Tapes in the Surgical Management of Mixed Urinary Incontinence

T2 - 3-Year Outcomes of a Randomized Controlled Trial

AU - Abdel-Fattah, Mohamed

AU - Hopper, Laura R.

AU - Mostafa, Alyaa

PY - 2014/1

Y1 - 2014/1

N2 - Purpose: We evaluate the clinical effectiveness of transobturator tension-free vaginal tape procedures in the surgical management of mixed urinary incontinence in women at 3-year followup.Materials and Methods: In this secondary analysis of a prospective, single-blind, randomized controlled trial 83 of 341 women (24%) with mixed urinary incontinence were randomized to undergo an outside-in (Aris (R) transobturator sling system 42) or inside-out (TVT (TM)-O 41) transobturator tension-free vaginal tape procedure. Patients were contacted by postal questionnaire at a minimum of 3 years postoperatively. The primary outcome was the patient reported success rate, defined as very much improved/much improved on the PGI-I (Patient Global Impression of Improvement). Secondary outcomes included improvement in quality of life, impact on preoperative urgency/urgency incontinence and repeat surgical treatment for stress urinary incontinence. Outcomes at 3 years were compared between groups (outside-in vs inside-out) and to 1-year outcomes. Analysis was performed using SPSS (R) version 20 with significance levels set at p = 0.05.Results: A total of 66 women with mixed urinary incontinence completed the 3-year followup (outside-in 35 vs inside-out 31). In each group 2 women underwent further continence surgery. The patient reported success rate was 73.8% with no significant differences between the groups (OR 1.035, 95% CI 0.342-3.134, p = 0.951). Overall 34 (50.1%) and 26 women (56.5%) reported cure of preoperative urgency and urgency incontinence, respectively, and 52 women (86.7%) had a clinically significant improvement in quality of life (18 points or more in total KHQ [King's Health Questionnaire] score) compared to baseline.Conclusions: Transobturator tape procedures are associated with a good (73.8%) patient reported success rate at a minimum of 3 years of followup in the surgical management of mixed urinary incontinence in women with predominant stress urinary incontinence symptoms. Nearly half of the women reported cure of urgency/urgency incontinence.

AB - Purpose: We evaluate the clinical effectiveness of transobturator tension-free vaginal tape procedures in the surgical management of mixed urinary incontinence in women at 3-year followup.Materials and Methods: In this secondary analysis of a prospective, single-blind, randomized controlled trial 83 of 341 women (24%) with mixed urinary incontinence were randomized to undergo an outside-in (Aris (R) transobturator sling system 42) or inside-out (TVT (TM)-O 41) transobturator tension-free vaginal tape procedure. Patients were contacted by postal questionnaire at a minimum of 3 years postoperatively. The primary outcome was the patient reported success rate, defined as very much improved/much improved on the PGI-I (Patient Global Impression of Improvement). Secondary outcomes included improvement in quality of life, impact on preoperative urgency/urgency incontinence and repeat surgical treatment for stress urinary incontinence. Outcomes at 3 years were compared between groups (outside-in vs inside-out) and to 1-year outcomes. Analysis was performed using SPSS (R) version 20 with significance levels set at p = 0.05.Results: A total of 66 women with mixed urinary incontinence completed the 3-year followup (outside-in 35 vs inside-out 31). In each group 2 women underwent further continence surgery. The patient reported success rate was 73.8% with no significant differences between the groups (OR 1.035, 95% CI 0.342-3.134, p = 0.951). Overall 34 (50.1%) and 26 women (56.5%) reported cure of preoperative urgency and urgency incontinence, respectively, and 52 women (86.7%) had a clinically significant improvement in quality of life (18 points or more in total KHQ [King's Health Questionnaire] score) compared to baseline.Conclusions: Transobturator tape procedures are associated with a good (73.8%) patient reported success rate at a minimum of 3 years of followup in the surgical management of mixed urinary incontinence in women with predominant stress urinary incontinence symptoms. Nearly half of the women reported cure of urgency/urgency incontinence.

KW - urinary incontinence

KW - suburethral slings

KW - urodynamic stress-incontinence

KW - sexual function

KW - midurethral slings

KW - impact

KW - women

KW - surgery

KW - complications

KW - urge

U2 - 10.1016/j.juro.2013.07.035

DO - 10.1016/j.juro.2013.07.035

M3 - Article

VL - 191

SP - 114

EP - 119

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 1

ER -