The tension-free transvaginal tape procedure in the treatment of female urinary stress incontinence: A French prospective multicentre study

Objective: To evaluate in a prospective multicentre study (five centres) th e preliminary results regarding efficacy and morbidity of the new tension-f ree transvaginal tape (TVT) technique in the treatment of urinary stress in continence (USI) in women. Methods: From November 1996 to May 1999, 52 women of mean age 64 (range 37- 91) years underwent the TVT procedure to treat isolated grade 2 or 3 USI (4 4 cases) or grade 1 or 2 USI associated with uterine or rectal prolapse sur gery (8 cases). Twenty-nine patients (55.8%) presented recurrent USI (1-4 p revious procedures). Clinical data showed urethrovesical junction hypermobi lity in 35 cases (67.3%), isolated intrinsic sphincter deficiency (ISD) in 17 cases (32.6%) and pelvic organ prolapse in 8 cases, Urodynamics confirme d ISD in 27 cases (51.9%) with a mean urethral closure pressure of 18.5 (ra nge 7-25) cm H2O. All data were collected by surgeons on a questionnaire. Results: The surgical procedure was performed under spinal cord anaesthesia in 82.7% of patients (local anaesthesia 11.5%) with a mean operation time of 30 (range 20-60) min for TVT implantation. Six bladder injuries (11.5%) were identified and the needle was repositioned. Mean hospital stay was 2.5 (range 1-7) days in the group who underwent TVT alone. Mean follow-up of c ontinence was 15.2 (range 6-36) months: 83% of patients were dry and 17% we re improved. Nine patients (17.3%) required self-catheterization for 2-10 d ays postoperatively. No recurrence of USI, defect healing or tape rejection were reported. Conclusion: TVT is anew technique for the surgical treatment of USI which i s useful for recurrent cases. The advantages are simplicity, low morbidity, reproducibility and reduced operative time. These early results indicate t he technique is effective in correcting incontinence and is locally well to lerated. But these are preliminary data and the long-term outcome on USI an d the urethra is needed. Copyright (C) 2001 S. Karger AG, Basel.