Long-term durability, functional outcomes, and factors associated with surgical failure of tension-free vaginal tape procedure.

purposeThe cure rate of tension-free vaginal tape (TVT) appeared to decrease overtime, with an associated increased in the stress urinary incontinence (SUI) recurrence rate. We evaluated the long-term durability and functional outcomes of TVT and identified the risk factors that may affect recurrence.

methodsEighty-eight patients, who were cured of SUI 6 months after undergoing TVT, were followed-up for at least 12 years. At post-operative, the patients were evaluated with a Severity Index for Urinary Incontinence questions regarding cure, patient's satisfaction, goal achievement, 3-day voiding diary with urinary urgency scale, uroflowmetry, and complications.

resultsCure rates decreased from 96.6 % at 1-year post-surgery to 83.0 % at 5 years and that the cure rates between 5 and 12 year were similar (83.0 vs. 79.6 %). Valsalva leak point pressure (VLPP) < 60 H(2)O was the only independent factor that predicted recurrence (p = 0.011; hazard radio 5.31). At last follow-up, 39.2 and 70.0 % of patients were free of urgency and urgency incontinence, respectively; and de novo urgency and urgency incontinence developed in 40.5 and 17.2 % of these patients, respectively. Age was the only factor that predicted freedom from overactive bladder (OAB) symptom. There was a significant reduction in the maximal flow rate from 23.3 ± 9.0 ml/s pre-operation to 18.8 ± 6.7 ml/s at 12 years post-operation.

conclusionsTVT is an effective long-term treatment for SUI, although the cure rate may decrease with time. A low VLPP was predictive of SUI recurrence, and patients showing no OAB symptoms tended to be younger.