Reasons for dissatisfaction ten years after TVT procedure

Area of Science:

• Urology
• Gynecology
• Female Pelvic Medicine

Background:

• Mid-urethral sling (MUS) procedures are common for stress urinary incontinence (SUI).
• Long-term patient satisfaction and reasons for dissatisfaction after MUS are not fully understood.
• Assessing outcomes requires understanding patient-reported reasons beyond initial surgical success.

Purpose of the Study:

• To investigate the long-term reasons for dissatisfaction following transvaginal tape (TVT) surgery for SUI.
• To identify the primary causes of patient discontent 10 years after TVT placement.
• To evaluate the persistence of lower urinary tract symptoms post-MUS.

Main Methods:

• A cohort study included patients who underwent TVT surgery between 1999 and 2001.
• Follow-up was conducted at a median of 116 months (approximately 10 years).
• Patients who did not consider themselves cured were surveyed for their specific reasons for dissatisfaction.

Main Results:

• Out of 210 patients, 141 (81%) were available for long-term follow-up.
• Among 56 dissatisfied patients, overactive bladder (OAB) symptoms were cited by 52% (n=29).
• Stress urinary incontinence (SUI) was a reason for dissatisfaction in 23% (n=13), and mixed incontinence in 14% (n=8).
• 85% of patients with ongoing urgency and 66% with SUI at follow-up reported dissatisfaction.

Conclusions:

• Overactive bladder symptoms are the predominant cause of dissatisfaction years after TVT surgery.
• The findings suggest that OAB symptoms may persist or develop post-MUS, impacting long-term outcomes.
• Composite outcome measures, including OAB symptoms, are recommended for evaluating the success of incontinence surgery.