Tension-free vaginal tape sling procedure for the treatment of stress urinary incontinence in Hong Kong women with and without pelvic organ prolapse: 1-year outcome study.

OBJECTIVE To assess the outcome of patients who underwent a tension-free vaginal tape sling procedure alone versus patients who underwent concomitant pelvic floor surgery. DESIGN Retrospective cohort study. SETTING Urogynaecology unit of a university teaching hospital, Hong Kong. PATIENTS Patients diagnosed with moderate-to-severe urodynamic stress incontinence and underwent a tension-free vaginal tape sling procedure from September 1999 to August 2004. MAIN OUTCOME MEASURES Objective cure rate of stress urinary incontinence 1 year following tension-free vaginal tape sling procedure was assessed. Patients were considered objectively cured if no stress urinary incontinence was evident on urodynamic studies at 1-year follow-up. Subjective cure rates at 4 months and 1 year after tension-free vaginal tape sling procedure were also assessed. Other outcome measures included intra-operative and perioperative complication rates, and the rate of de-novo detrusor overactivity at 1 year. RESULTS Of 302 patients recruited, 250 (82.8%) completed 1-year follow-up. There were 157 (62.8%) patients who had a tension-free vaginal tape sling alone, and 93 (37.2%) had tension-free vaginal tape sling and concomitant pelvic floor surgery for pelvic organ prolapse. All patients had urodynamic studies before and 1 year following surgery. The objective cure rate was 87.3% for patients with tension-free vaginal tape sling alone, and 80.6% for tension-free vaginal tape sling with concomitant procedures (Chi squared test, P>0.05). The subjective cure rates for tension-free vaginal tape sling alone and tension-free vaginal tape sling plus concomitant procedures were 89.2% and 86.0% at 4 months, and 93.0% and 94.6% at 1 year, respectively (Chi squared test, P>0.05). The most common complication was postoperative urinary retention (15.2%), followed by de-novo detrusor overactivity at 1 year (10%), and bladder perforation (8%). CONCLUSION The tension-free vaginal tape sling procedure alone or in combination with pelvic floor surgery are equally effective for the treatment of female stress urinary incontinence.