The tension-free vaginal tape in women with a non-hypermobile urethra and low maximum urethral closure pressure

The objective of this study was to estimate the cure rate and to identify risk factors that predict failure of the tension-free vaginal tape (TVT) in women with stress urinary incontinence (SUI), a non-hypermobile urethra, and low maximum urethral closure pressure. Thirty-six women with SUI, a non-hypermobile urethra (straining urethral angle <= 35 degrees), and low maximum urethral closure pressure (MUCP <= 25 cm H2O) underwent a TVT. Cure was defined as resolution of subjective SUI symptoms and a negative cough stress test, which were measured after 4, 12, 18, and 24 months. Patient characteristics were compared and receiver-operator curves were used to identify risk factors for failure. The mean age was 71 years, and mean follow-up was 20.9 months. The overall cure rate was 78%. Risk factors for failure of the TVT were a straining urethral angle <= 20 degrees (cure rate 50%, odds ratio 7.7, p=0.02) and a MUCP <= 15 cm H2O (cure rate 60%, odds ratio 6.3, p=0.03). For women with both risk factors, the cure rate was only 17% (p=0.001). No other risk factors were identified. The TVT has moderate success (50-60%) for women with SUI and one risk factor (a straining urethral angle </=20 degrees or a MVCP </=15 cm H2O), but has poor success (17%) when both risk factors are present.