Clinical audit of the use of tension-free vaginal tape as a surgical treatment for urinary stress incontinence, set against NICE guidelines.

Urinary incontinence affects a large proportion of adult women and is associated with considerable distress and social disability. In February 2003 the UK National Institute for Clinical Excellence (NICE) published new clinical guidelines on the use of tension free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. Against these guidelines we have conducted a retrospective audit of patient care by the Oxford Radcliffe NHS Trust over 3 years, using the BFLUTS questionnaire in conjunction with patient records. This is believed to be the first such audit. Our results show overall performance to be satisfactory with no major problems. For all women the type of incontinence was confirmed by urodynamic investigation and in 92% of cases conservative management was tried and had failed before surgery was considered. For the TVT operation patients reported a high subjective cure rate, with 95% either fully cured or showing substantial improvement in their condition. Incidences of the main complications of TVT were found within statistical limits to be low (bladder/urethral perforation 4%; haemorrhage 1%; long-term voiding dysfunction 2%; tape rejection 0%; defective healing 0%; de novo urine retention 12%). These levels are similar to those reported elsewhere in the literature. However, a quarter of patients either did not receive full information about the TVT procedure in order to make an informed choice, or this was not documented. To improve care we recommend that local agreement should be reached between clinicians on information that will be provided to the patient as part of the consent process.