Female urinary incontinence repair by Prolene(R) TVT. Preliminary results of multicentre, prospective survey.

Objectives: A multicentre, prospective study (6 private centres, 1 general hospital and 1 teaching hospital) was conducted to evaluate the perioperati ve morbidity and short-term functional results of the TVT procedure in the treatment of the female urinary stress incontinence. Patients and Methods: From November 1996 to September 1999, 120 patients,vi th a mean age of 65.2 years (range: 37-91) were operated according to the t ension-free vaginal tape (TVT) technique for isolated urinary stress incont inence (stage 2 or 3) in 94 cases and associated with pelvic tone disorder in 26 cases, 59 patients (49.2%) presented recurrence of urinary incontinen ce that had already been operated between 1 and 4 times. Physical examinati on demonstrated hypermobility of the urethra in 73 cases (60.8%), isolated clinical sphincter incompetence in 47 cases (39.2%) and pelvic tone disorde rs in 31 cases. Urodynamic studies, performed in 113 patients, demonstrated sphincter incompetence in 65 cases (57.5%) with a mean maximum urethral cl osure pressure of 18 cmH2O (range: 5-29). Results: The operation, performed tinder spinal anaesthesia in 97 cases (80 .8%), general anaesthesia in 16 cases (13.3%) and local anaesthesia in 7 ca ses (5.8%) lasted an average of 28.7 min (range: 15-60) for insertion of th e TVT. Perioperative complications consisted of twelve bladder injuries (10 %) and two pelvic haematomas (1.7%). No cases of infection erosion or migra tion bf the tape were reported In the group of 94 patients operated exclusi vely by TVT the mean hospital stay was 2.6 days (range: 1-7). Twelve patien ts (10%) required self-catheterization for 2 to 30 days. With a mean follow -up of 15.2 months (range: 36-6), continence was restored in 104 patients, corresponding to a care rate of 86.7%. A marked improvement was obtained in 11 cases (9.2%) and five cases (4.2%) were considered to be failures. Conclusion: The TVT procedure is a new approach to the treatment of female urinary stress incontinence. Its advantages are its simplicity, the rapidit y of the technical procedure and the short-term efficacy on continence. A l onger follow-up is essential to assess to the functional outcome and the lo ng-term urethral tolerance.