NEUROUROLOGY & FEMALE UROLOGY

Does the tension-free vaginal tape procedure (TVT) affect the voiding function over time? Pressure-flow studies 1 year and 3(1/2) years after TVT
Sander P, Sørensen F, Lose G
Department of Obstetrics and Gynaecology, Glostrup County Hospital, University of Copenhagen, Glostrup, Denmark
Neurourol Urodyn. 2007; 26: 995-7

• Aim: The aim was to evaluate the voiding function over time after the TVT procedure for stress incontinence.
• Materials and Methods: Thirty-eight women with urodynamic stress urinary incontinence were included in the study. For voiding function assessment the patients were asked if voiding had changed postoperatively, and objectively uroflowmetry, residual urine measurement and pressure-flow were performed preoperatively, 1 year and 3(1/2) years postoperatively.
• Results: At 1/3(1/2) years follow-up 87%/69% were subjectively cured and 13%/26% improved, respectively. The objective cure rate was 89%/74%. Subjectively 77%/63% of the patients felt an altered voiding function towards more difficult voiding one and 3(1/2) years after surgery, respectively. Objectively all the uroflowmetry variables deteriorated and residual urine volume increased over time although the changes were not statistically significant between the 1 and 3(1/2) years follow-up. Pressure-flow variables were essentially unchanged.
• Conclusion: The changes in voiding function after a TVT do not reverse over time. This may imply a potential risk of development of clinically important impaired emptying function.
  
  
• Editorial Comment
  The authors of this paper reviewed both subjective as well as objective data in evaluating voiding habits and bladder function 1 year and 3(1/2) years after placement of a TVT. The researchers found that there was a steady deterioration in uroflow measures as well as an increase in residual urine between the initial and long-term follow-up. Urodynamic criteria were essentially unchanged.
  This study is quite interesting in that it explores the question of what happens long-term to voiding function after a no-tension technique anti-incontinence operation. Those patients will often view a successful operation as imperfect based on voiding habits has previously been reported (1) and is well evidenced here by comparing the patient perceptions with the pad and leakage episodes reported in the manuscript table. The noted worsening of uroflow measures and the increase in post void residuals from the 1 year mark to 3(1/2) years mark raises the concern of what happens to the younger patient who has an anti-incontinence procedure at the time of her pelvic prolapse surgery in her forties: is she doomed to a life of voiding dysfunction and possible pharmacological therapy from age 60 onwards? This should be food for thought for the clinician who adds a sling as a prophylactic step to the prolapse surgery planned.

Reference
1. Haab F, Trockman BA, Zimmern PE, Leach GE: Results of pubovaginal sling for the treatment of intrinsic sphincter deficiency determined by questionnaire analysis. J Urol. 1997; 158: 1738-41.

Dr. Steven P. Petrou
Associate Professor of Urology
Chief of Surgery, St. Luke’s Hospital
Associate Dean, Mayo School of Graduate Medical Education
Jacksonville, Florida, USA
E-mail: petrou.steven@mayo.edu