Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence—A long-term follow-up

doi:10.1016/j.ejogrb.2006.04.012

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 132, Issue 1, May 2007, Pages 121-125

https://doi.org/10.1016/j.ejogrb.2006.04.012 Get rights and content

Abstract

Background

To determine risk factors for the appearance of de novo urgency symptoms, and subsequent accompanying problems, after the tension-free vaginal tape (TVT) procedure in women with stress urinary incontinence.

Method

A structured preoperative analysis of the incontinence symptoms was made. A mailed questionnaire was distributed to 970 women that underwent the TVT procedure between 1995 and 2001. Average follow-up was 5.2 years (range 2–8 years). The questionnaire included specific questions on current urinary symptoms and incontinence. The disease-specific quality of life instruments IIQ-7 and UDI-6 were used to compare women with, and those without de novo urgency.

Results

Seven hundred and sixty women (78.3%) responded and 463 of those were identified as genuine stress incontinence preoperatively. De novo urgency occurred in 67 (14.5%) of the women. The frequency was similar irrespective of duration since the TVT procedure. The women that reported de novo urgency symptoms were compared with those without symptoms. Risk factors for occurrence of de novo urgency symptoms were older age (64.7 years versus 60.9 years; p = 0.01), parity (2.6 versus 2.3; p = 0.05), history of cesarean section (9.5% versus 2.5%; odds ratio 5.4), and history of recurrent urinary infections (29.7% versus 18.8%; odds ratio 1.6, but non-significant. De novo urgency had a severe impact on quality of life, as compared to the remaining study population.

Conclusion

Old age, parity and history of cesarean section were risk factors for de novo urgency after TVT surgery. Postoperative de novo urgency symptoms are as bothersome for the patient as the preoperative stress urinary incontinence.

Introduction

Since the introduction of the tension-free vaginal tape (TVT) procedure in 1995 [1], the method has gained increasing popularity for treatment of female stress urinary incontinence and is at present one of the most used methods for incontinence surgery [2]. The success rates after TVT are high and complications are few.

De novo urgency symptoms, with or without incontinence episodes have been a problem after all types of incontinence surgery [3], [4], [5], [6]. Methods such as colposuspension [6], Burch colposuspension [3], [5] and pubovaginal sling [4] have been reported to be associated with de novo urgency side effects in 12–21%, and lower or higher figures have also been reported [7].

There is no widely accepted definition of de novo urgency. A prerequisite is that the patient had no problem with urgency symptoms preoperatively. Because of the insensitivity of urodynamic investigations, the patient's own experience of symptoms must be in focus. Finally, irritating symptoms following the first months after surgery should not be diagnosed as de novo urgency; the symptoms must be persistent [7].

It is understandable, that although with excellent results in curing the stress incontinence, few women will be happy when one incontinence type is switched to another. Urgency incontinence is in general more bothersome for the women, than stress incontinence. The immediate and irresistible drive to micturate, nocturnal enuresis and pain are in general no problems associated with stress incontinence.

Section snippets

Material and methods

The entire study included 970 consecutive TVT procedures performed at the Department of Obstetrics and Gynecology, Falun Hospital between October 1995 and December 2001.

Initially, one surgeon, trained at the Department of Obstetrics and Gynecology, University Hospital, Uppsala, where TVT was initiated and developed, performed the operations. Under his guidance, experienced gynecologists soon began to practice the TVT procedure. Today, most of our gynecological surgeons perform the operation. In

Results

When preoperative mixed incontinence and transient postoperative urgency symptoms (n = 37) were excluded, 463 (60.9%) of the 760 women who responded to the questionnaire (78.3%) were identified as having only stress incontinence preoperatively. Sixty-seven (14.5%) of these women reported persistent de novo urgency symptoms postoperatively, among whom 51 women also had actual incontinence episodes. The remaining 396 women reported no urgency symptoms and were used as a comparison group.

Fig. 1

Discussion

This study was able to define some risk groups for de novo urgency symptoms, e.g. old age, obesity, parity and history of cesarean section. The numerical difference between the women with de novo urgency and non-affected women of complaints of preoperative recurrent urinary tract infections was quite large, but non-significant. Although significant, the actual differences in body mass index and parity were small. Thus, in this study, age and a history of cesarean section were the most important

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Frequency of de novo urgency in 463 women who had undergone the tension-free vaginal tape (TVT) procedure for genuine stress urinary incontinence—A long-term follow-up

Abstract

Background

Method

Results

Conclusion

Introduction

Section snippets

Material and methods

Results

Discussion

J Urol

BJOG

Urology

J Urol

J Am Coll Surg

Maturitas

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Scand J Urol Nephrol

Complications of tension-free vaginal tape surgery: a multi-institutional review

BJU Int

Burch colposuspenion for stress urinary incontinence. 5-year results in 153 women

Scand J Urol Nephrol