The Comparison of Tension-Free Vaginal Tape Procedure in the Management of Stress Urinary Incontinence Caused by Anatomical Incontinence and Intrinsic Sphincter Deficiency

Cho, Dae Yeon; Lee, Jeong Gu

Abstract

PURPOSE: Recently, tension free vaginal tape (TVT) has been widely used in the management of stress urinary incontinence (SUI), and has been applied to SUI by intrinsic sphincter deficiency (ISD). This study was performed to identify the efficacy of the TVT procedure in SUI patients by ISD.
MATERIALS AND METHODS
A total of 196 incontinent women, who underwent TVT procedures were enrolled in this study. The patients were divided into four groups according to their preoperative Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP): Group I (anatomical incontinence, AI, n=78), Group II (mild ISD: 40cmH2O < or=VLPP<60cmH2O, n=54), Group III (moderate ISD: MUCP< or=20cmH2O or 30cmH2O< or=VLPP<40cmH2O, n=38) and Group IV (severe ISD: MUCP< or= 10cmH2O or VLPP< or=30cmH2O, n=26). One year after the TVT procedure, a symptom questionnaire and the urodynamic parameters were compared with the preoperative data.
RESULTS
There were no significant differences in the Q-tip test, peak uroflow (Qmax) and post-voiding residual volume among the four groups preoperatively. There were no significant differences in success rates between ISD and AI. The postoperative cure rates were 82% (64/78) and 78% (92/118) for AI and ISD, respectively. In an urodynamic analysis, Groups III and IV the postoperative Q max were significantly decreased compared with Groups I and II, and the postoperative voiding difficulties were significantly higher in Groups III and IV (p<0.05).
CONCLUSIONS
The TVT procedure showed high cure rates of SUI in the mild ISD and AI groups compared with those in the moderate and severe ISD groups. The rates of voiding difficulty were more frequent in moderate and severe ISD groups. According to our results, it can be suggested that TVT can be undertaken for stress incontinent women associated with ISD.