Tension-free vaginal tape (TVT) in stress incontinent women with intrinsicsphincter deficiency (ISD) - A long-term follow-up

In a prospective long-term study 49 women with stress incontinence and ISD (intrinsic sphincter deficiency) were followed for a mean of 4 years (range 3-5) after TVT operation. Preoperatively all patients underwent urodynamic investigations, quality of life evaluation, a 24-hour pad test and a gynec ologic examination to properly verify the incontinence symptoms. The same p rotocol was used for postoperative evaluation. The mean age of the women wa s 66 years (+/- 11) and mean parity 2 (range 0-4). A standard TVT operation was performed under local anesthesia. At the postoperative evaluations 36 patients (74%) were completely cured of their incontinence problems. In add ition, 6 women (12%) were significantly improved. In 7 patients (14%) no im provement was found. The majority of these not cured patients were >70 year s of age and had urethral resting pressure of <10 cmH(2)O. Few intra- and p ostoperative complications occurred. It is concluded that TVT can be used f or surgical treatment of patients with ISD and stress incontinence. However , older patients (>70 years) with a very low resting urethral pressure and an immobile urethra seem to constitute a risk group where TVT surgery is le ss successful.