PURPOSE: To evaluate the clinical effectiveness of transobturator tension-free vaginal tapes (TO-TVT) in the surgical management of women with mixed urinary incontinence (MUI) at 3 years follow-up.
MATERIALS AND METHODS: Secondary analysis of a prospective single-blinded RCT; 83/341 women (24%) with MUI were randomised to undergo outside-in (TOT-Aris®, n=42) or inside-out (TVT-O™, n=41) TO-TVT. Patients were contacted by postal questionnaire at a minimum of 3 years postoperative. Primary outcome was the patient-reported success rate, defined as "very much improved/much improved" on Patient Global Impression of Improvement (PGI-I). Secondary outcomes included: improvement in quality of life (QoL), impact on pre-operative urgency/ urgency incontinence and repeat surgical treatment for SUI. Outcomes at 3-years were compared between groups (outside-in vs. inside-out) and to 1-year outcomes. Analysis was performed using SPSS version 20 with significance levels set at p=0.05.
RESULTS: 66 women with MUI completed the 3-years follow-up (outside-in (n=35) vs. inside-out (n=31); 2 women in each group underwent further continence surgery. Patient-reported success rate was 73.8% with no significant differences between groups (OR 1.035; 95% CI 0.342-3.134; p=0.951). 34 (50.1%) and 26 women (56.5%) reported cure of their pre-operative urgency and urgency incontinence respectively; 52 women (86.7%) showed a clinically significant improvement in QoL (≥18 points in total KHQ score) compared to baseline.
CONCLUSIONS: Transobturator tapes are associated with good (73.8%) patient-reported success rate at a minimum of 3 years follow-up in the surgical management of women with MUI and predominant SUI symptoms. Almost half of the women reported cure of urgency/ urgency incontinence.
Written by:
Abdel-Fattah M, Hopper LR, Mostafa A. Are you the author?
Senior Clinical Lecturer/ Consultant Urogynaecologist - University Of Aberdeen.
Reference: J Urol. 2013 Jul 24. pii: S0022-5347(13)04916-1.
doi: 10.1016/j.juro.2013.07.035
PubMed Abstract
PMID: 23892190
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