FEMALE UROLOGY

A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up
Ward KL, Hilton P; UK, and Ireland TVT Trial Group
Department of Obstetrics and Gynaecology, University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
Am J Obstet Gynecol. 2004; 190: 324-31

• Objective: This study was undertaken to compare tension-free vaginal tape (TVT) with colposuspension as the primary treatment for stress incontinence.
• Study Design: The trial was conducted in gynecology or urology departments in 14 centers in the United Kingdom and Ireland. Three hundred forty-four women with urodynamic stress incontinence were randomly assigned to groups: 175 to TVT and 169 to colposuspension. Patients were assessed using the Short Form-36 health status questionnaire, the Bristol Female Lower Urinary Tract Symptoms questionnaire, clinical examination, and a 1-hour perineal pad test. Unpaired and paired data were analyzed with the Wilcoxon rank sum and matched pairs tests, respectively, and proportions were compared with the Fisher exact test.
• Results: When data were analyzed on an intention-to-treat basis, assuming patients with missing data to be treatment failures, 63% of the TVT group and 51% of the colposuspension group were objectively cured at 2 years (odds ratio 1.67, 95% CI 1.09-2.58).
• Conclusion: The TVT procedure appears to be as effective as colposuspension for the treatment of urodynamic stress incontinence at 2 years.
  
  
• Editorial Comment
  The authors publish a follow up article to their six-month outcomes report between tension-free vaginal tape (TVT) and colposuspension (1). This is an excellent paper, which addresses surgical outcomes in patients who were randomized to one of the two anti-incontinence procedures. The paper’s strength lies in its strict measurement tools including validated questionnaires, clinical examinations and pad tests. The comments section holds an interesting discussion regarding the possible patient desire for minimally invasive surgery to explain the differentially higher withdrawal rate after randomization but before surgery in the colposuspension group as opposed to the TVT group. This preference has been previously noted (2).

References
1. Ward K, Hilton P: Prospective multicentre randomized trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ 2002; 325: 67-70.
2. Karantanis E, Stanton S, Parsons M, Robinson D, Blackwell AL, Cardozo L, et al.: Women’s preference for treatment for stress incontinence - physiotherapy or surgery [abstract]. Neurourol Urodyn. 2003; 22: 522-3.

Dr. Steven P. Petrou
Associate Professor of Urology
Mayo Clinic College of Medicine
Jacksonville, Florida, USA