Aim of the study:
Tension-free Vaginal Tape has been used for the last 5 years for the management of women with genuine stress incontinence, as a minimally invasive procedure(1).It appears to be very effective with low complications rates and fast postoperative recovery (2,3), but more studies are needed for safe conclusions to be made. Objective of this study was to assess the effectiveness and the complications associated with Tension-free Vaginal Tape (TVT) for the management of genuine stress incontinence in women and also to assess the possibility of using TVT in combination with operative procedures for the management of genital prolapse.

Methods:
59 patients with the diagnosis of genuine stress incontinence (GSI) participated in the study. 37 patients had GSI with first degree genital prolapse or less according to the International Continence Society classification, 11 patients had stage II -Cx genital prolapse and GSI , 4 patients had stage III -Cx prolapse and GSI, 6 patients had previous anterior colporraphy and 1 patient had a previous Marshall-Marchetti -Crantz operation performed .The patients with GSI and genital prolapse stage II or more underwent vaginal hysterectomy with anterior and posterior colporraphy plus TVT. All patients had a medical history taken and a clinical examination performed at initial visit and subsequently, they had frequency- volume charts to complete for 3-4 days and filling and voiding cystometry performed before and 3 months after the operation. All the patients were comparable in relation to their age and parity and body mass index (BMI) (Table I). Mean follow-up time was 21 months. Statistical analysis was performed with the use of Student's t-test with p<0.05 considered statistically significant.

Results:
The patients without previous operation and genital prolapse stage I or less had a success rate of 93% at 1 year and 84% at 22 months. The patients with previous operation for GSI had a success rate of 50% at 6 months and 45% at 22 months follow-up, while the patients with GSI and genital prolapse stage II or more had a success rate 94% at 1 year and 88% at 20 months follow-up. We had no cases of postoperative bleeding or hematoma development, while perforation of the bladder occurred in 4 cases (4/59). Postoperative urinary tract infection developed in 5 cases (5/59). Mean operative time for TVT was 27 minutes and the mean hospitalization time was 2.2 +1.1 days. Postoperative de novo instability for TVT was 15% at 3 months follow-up.

Conclusion.
The application of TVT procedure in the management of GSI in women appears to be a very promising method with short duration of hospitalization ans very low incidence of severe complications. The postoperative development of de novo detrusor instability responded well to pharmaceutical treatment and has probably to do with the technique used. Tight application of TVT tape below the urethra could cause a significant degree of obstruction without necessarily improving the success rate. TVT procedure could probably effectively be combined with vaginal hysterectomy and anterior colporraphy in patients with GSI but further studies are needed for safe conclusions to be made. Further evaluation of TVT procedure with assessment of success rate at 5 and 10 years is required in order to assess the long term effectiveness of the procedure.

References:
1. Int Urogynecol J 1999; 7:81-86.
2. Br J Obstet Gynecol 1999; 106: 345-350.
3. J Reprod Med 1998; 43: 429-433.

Table 1. Patients characteristics.

BMI: Body mass index