Sonographic sling position and cure rate 10-years after TVT-O procedure

Purpose:

We examined the position of the TVT-O sling 10 years postoperatively and its association with outcome.

Materials and Methods:

A total of 124 patients who received a TVT-O sling at two centers in 2004 and 2005 were invited for follow-up. The position of the sling on perineal ultrasound was described relative to the bladder neck and the lower margin of the pubic symphysis at rest and on Valsalva. Objective cure was defined as a negative cough stress test at 300 ml. Subjective cure was evaluated with the Kings' Health Questionnaire (KHQ), Incontinence Outcome Questionnaire (IOQ), Female Sexual Function Index Questionnaire (FSFI) and the Patient Global Impression of Improvement score (PGII).

Results:

78 of 124 patients (57%) were available for follow-up 10 years after surgery. 11 (14%) had undergone reoperation and were excluded, leaving 67 patients for the present study. Tapes were visualized in all women. The subjective and objective cure rates were 67% (45/67) and 77% (52/67), respectively. The mean distances from the bladder neck to the proximal edge of the tape (BNTD) during Valsalva maneuver were significantly higher in cured women compared to the not-cured women (11.2 vs. 9.4 mm). The distance between tape and urethra (TUD) was significantly lower in cured vs. not cured patients (2.6 vs. 4.1 mm). All women with a TUD of > 5 mm (n = 5) were incontinent. Tape position was not associated with OAB symptoms.

Conclusions:

Tape position near the bladder neck and large distance to the urethra is associated with incontinence 10 years after TVT-O.