Korean J Urol.  2012 Mar;53(3):184-188.

Long-term Clinical Outcomes of the Tension-free Vaginal Tape Procedure for the Treatment of Stress Urinary Incontinence in Elderly Women over 65

• Jun KK
• Oh SM
• Choo GY
• Park HK
• Paick SH
• Lho YS
• Kim HG

Abstract

PURPOSE
The aim of this study was to assess the long-term clinical outcomes of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence (SUI) in elderly women and to identify the factors influencing failure in these cases.
MATERIALS AND METHODS
Women with SUI who underwent a TVT procedure were studied. "Cure" was defined as no urine leakage at all in any circumstances and "improvement" was defined as some urine leakage but a score of over 4 points out of 5 in a satisfaction inquiry. Patients were divided into two groups (middle-aged, <65 years and elderly, > or =65 years) for comparison of clinical outcomes. In the elderly group, patients were subdivided into two groups (cure and no cure groups) and were compared to identify the factors influencing failure.
RESULTS
A total of 136 women (middle-aged group, 106; elderly group, 30) were enrolled in the study. The mean ages of the patients in the 2 groups were 53.5+/-5.9 and 72.0+/-5.0 years and the mean follow-up times were 50.5+/-9.4 and 48.8+/-9.1 months, respectively. The cure and improvement rates in the middle-aged and elderly groups were 80.2% vs. 66.7% and 4.7% vs. 3.3%, respectively (p>0.05). The satisfaction scores in the middle-aged and elderly groups were 3.8+/-1.1 vs. 3.3+/-1.5 points (p>0.05). In the elderly group, the body mass index of the cure and no cure groups were 24.6+/-3.3 kg/m2 and 26.6+/-1.0 kg/m2, and body mass index was the only factor that differed significantly between the two subgroups (p=0.028).
CONCLUSIONS
Our long-term results suggest that TVT is an effective treatment even in elderly women. However, elderly women who are obese should be counseled carefully about the success rate.

Keyword

Eldery; Stress; Suburethral slings; Urinary incontinence

MeSH Terms

Aged
Body Mass Index
Female
Follow-Up Studies
Humans
Suburethral Slings
Urinary Incontinence

Reference

1. Lee JH, Cho MC, Oh SJ, Kim SW, Paick JS. Long-term outcome of the tension-free vaginal tape procedure in female urinary incontinence: a 6-year follow-up. Korean J Urol. 2010. 51:409–415.

2. Walsh K, Generao SE, White MJ, Katz D, Stone AR. The influence of age on quality of life outcome in women following a tension-free vaginal tape procedure. J Urol. 2004. 171:1185–1188.

3. Sevestre S, Ciofu C, Deval B, Traxer O, Amarenco G, Haab F. Results of the tension-free vaginal tape technique in the elderly. Eur Urol. 2003. 44:128–131.

4. Allahdin S, McKinley CA, Mahmood TA. Tension free vaginal tape: a procedure for all ages. Acta Obstet Gynecol Scand. 2004. 83:937–940.

5. Sandvik H, Espuna M, Hunskaar S. Validity of the incontinence severity index: comparison with pad-weighing tests. Int Urogynecol J Pelvic Floor Dysfunct. 2006. 17:520–524.

6. Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996. 7:81–85.

7. McGrother C, Resnick M, Yalla SV, Kirschner-Hermanns R, Broseta E, Müller C, et al. Epidemiology and etiology of urinary incontinence in the elderly. World J Urol. 1998. 16:Suppl 1. S3–S9.

8. Lo TS, Huang HJ, Chang CL, Wong SY, Horng SG, Liang CC. Use of intravenous anesthesia for tension-free vaginal tape therapy in elderly women with genuine stress incontinence. Urology. 2002. 59:349–353.

9. Toglia MR, Nolan TE. Morbidity and mortality rates of elective gynecologic surgery in the elderly woman. Am J Obstet Gynecol. 2003. 189:1584–1587.

10. Stepp KJ, Barber MD, Yoo EH, Whiteside JL, Paraiso MF, Walters MD. Incidence of perioperative complications of urogynecologic surgery in elderly women. Am J Obstet Gynecol. 2005. 192:1630–1636.

11. Sung VW, Weitzen S, Sokol ER, Rardin CR, Myers DL. Effect of patient age on increasing morbidity and mortality following urogynecologic surgery. Am J Obstet Gynecol. 2006. 194:1411–1417.

12. Allahdin S, Harrild K, Warraich QA, Bain C. Comparison of the long-term effects of simple total abdominal hysterectomy with transcervical endometrial resection on urinary incontinence. BJOG. 2008. 115:199–204.

13. Morse AN, Labin LC, Young SB, Aronson MP, Gurwitz JH. Exclusion of elderly women from published randomized trials of stress incontinence surgery. Obstet Gynecol. 2004. 104:498–503.

14. Olsson I, Abrahamsson AK, Kroon UB. Long-term efficacy of the tension-free vaginal tape procedure for the treatment of urinary incontinence: a retrospective follow-up 11.5 years post-operatively. Int Urogynecol J. 2010. 21:679–683.

15. Liapis A, Bakas P, Creatsas G. Long-term efficacy of tension-free vaginal tape in the management of stress urinary incontinence in women: efficacy at 5- and 7-year follow-up. Int Urogynecol J Pelvic Floor Dysfunct. 2008. 19:1509–1512.

16. Nilsson CG, Falconer C, Rezapour M. Seven-year follow-up of tension-free vaginal tape procedure for treatment of urinary incontinence. Obstet Gynecol. 2004. 104:1259–1262.

17. Lee KS, Choo MS, Doo CK, Han DH, Lee YS, Kim JY, et al. The long term (5-years) objective TVT success rate does not depend on predictive factors at multivariate analysis: a multicentre retrospective study. Eur Urol. 2008. 53:176–182.

18. Liapis A, Bakas P, Christopoulos P, Giner M, Creatsas G. Tension-free vaginal tape for elderly women with stress urinary incontinence. Int J Gynaecol Obstet. 2006. 92:48–51.

19. Subak LL, Johnson C, Whitcomb E, Boban D, Saxton J, Brown JS. Does weight loss improve incontinence in moderately obese women? Int Urogynecol J Pelvic Floor Dysfunct. 2002. 13:40–43.

20. Cummings JM, Rodning CB. Urinary stress incontinence among obese women: review of pathophysiology therapy. Int Urogynecol J Pelvic Floor Dysfunct. 2000. 11:41–44.