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NEUROLOGY &
FEMALE UROLOGY
doi: 10.1590/S1677-553820100002000029
A
multicenter, prospective, randomized clinical trial comparing tension-free
vaginal tape surgery and no treatment for the management of stress urinary
incontinence in elderly women
Campeau L, Tu LM, Lemieux MC, Naud A, Karsenty G, Schick E, Corcos J
Department of Urology, Sir Mortimer B. Davis-Jewish General Hospital,
McGill University, Montreal, Canada
Neurourol Urodyn. 2007; 26: 990-4
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Aims: The aim of our study was to test the hypothesis that elderly
women undergoing tension-free vaginal tape surgery (TVT) will have
a better quality of life (QOL) and satisfaction compared to non-treated
women despite age- and technique-related potential morbidity.
Methods: This multicenter, prospective, randomized, controlled trial
enrolled a total of 69 women aged over 70 years who initially consented
to be randomized to either undergo immediate TVT surgery or to wait
for 6 months before submitting to the same surgery (control group).
The main outcomes measured at every visit (pre-randomization, 8-12
weeks and 6 months) consisted of the Incontinence-Quality of Life
(I-QOL) Questionnaire, the Patient Satisfaction Questionnaire and
the Urinary Problems Self-assessment Questionnaire, among others.
Results: The analysis included 31 patients in the immediate surgery
group and 27 subjects in the control group. Peri-operative complications
in the immediate surgery group were bladder perforation (22.6%), urinary
retention (12.9%), urinary tract infection (3.2%) and de novo urgency
(3.2%). At 6 months, the mean I-QOL scores for the TVT and control
groups were respectively 96.5 +/- 15.5 and 61.6 +/- 19.8 (P < 0.0001);
mean Patient Satisfaction scores were respectively 8.0 +/- 2.7 and
2.0 +/- 2.4 (P < 0.0001); and mean Urinary Problems scores were
respectively 4.5 +/- 4.3 and 11.6 +/- 3.5 (P < 0.0001).
Conclusion: At 6 months post-randomization, the group of elderly women
who underwent immediate TVT surgery showed a significant improvement
in QOL, patient satisfaction and less urinary problems compared to
the group of women waiting for the same surgery
- Editorial
Comment
The authors provide a study with the primary goal of deciding whether
elderly women who underwent surgery with its attendant risks would
have an improved quality of life and satisfaction than those patients
who deferred surgery and merely continued on in their state of incontinence
or in simpler terms: should an elderly woman have surgery or just
live with her symptoms. The population studied included patients that
either refused or failed conservative therapy and were on no medication
for bladder dysfunction (including overactive bladder or urinary tract
infection). The patients had no evidence of detrusor overactivity
and had normal compliance on cystometrogram. The patient population
was randomized to either having surgery immediately or waiting six
months and being reevaluated and then having their surgery at that
time. The metrics for both groups were quantified at baseline and
again at 6 months and then compared. The tools that were utilized
to assess the patient’s quality of life included the IQOL Questionnaire;
Patient Satisfaction scores; in addition to a Urinary Problems quantification.
The authors found that patients who had the surgery had improvement
in the measured parameters over those practicing watchful waiting
thus supporting their hypothesis that surgery was worthwhile over
watchful waiting in the elderly population.
This is an excellent paper to review when pondering whether to offer
surgery to an elderly woman versus telling her to live with her problem.
Many times, the surgeon must make the simple but really complex assessment
of whether the treatment will outweigh the cure; this report emboldens
one to choose intervention. The study begs the authors to take the
next step of determining if the same promise of therapy can be applied
to the super elderly population such as those of 80, 85 or 90 years
of age.
Dr.
Steven P. Petrou
Professor of Urology, Associate Dean
Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu
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