Tension Free Vaginal Tape Procedure in Incontinent Patients with Low Valsalva Leak Point Pressure

ABSTRACT

PURPOSE: To evaluate the outcome after the tension free vaginal tape (TVT) procedure in stress urinary incontinence with low Valsalva leak point pressure (VLPP), and identify factors predicting the outcome. MATERIALS AND METHODS: Two hyndred twenty-one women from 29 to 80 years old (mean 55.2) were included in the study. The TVT procedure was mostly performed under local anesthesia. The mean follow-up time was 10.5 months (range 6~52). Patients were divided into two groups (Group I VLPP or = 60 cmH2O, n=160). Cure of incontinence was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress test. RESULTS: The overall cure rate was significantly lower in Group I than in Group II (82.0% versus 93.1%, p= 0.013). In women with low VLPP, multivariate analysis indicated that urge symptom and low maximal urethral closure pressure were independent factors for the treatment failure (odds ratio, 15.12; 95% confidence interval, 1.90~120.61; p=0.010) for urge symptom and (odds ratio, 0.92; 95% confidence interval, 0.86~0.99; p=0.018) for maximal urethral closure pressure. CONCLUSION: The cure rate after the TVT procedure is lower in women with low VLPP, when compared to those with higher VLPP. Our findings suggest that urge symptom and low maximal urethral closure pressure should be considered to be at high risk of the failure after the TVT procedure in these patients.