TVT: Prospective study comparing preoperative and postoperative clinical, urodynamic and quality of life criteria

Introduction: This prospective study on TVT compared preoperative and postoperative urodynamic in order to evaluate the effects of TVT on the detrusor-sphincter synergy, and quality of life criteria by means of a validated questionnaire. Material and Method: From August 2000 to March 2002, the authors conducted a prospective study on two sites, Nice and Marseille, on 37 patients. The inclusion criteria were clinical and urodynamic. A questionnaire evaluating the severity of incontinence and its impact on daily life was completed preoperatively and postoperatively. Thirty TVTs were placed under local anaesthesia and seven TVTs were placed under general anaesthesia. Patients were reviewed at least 6 months (mean: 9 months; range: 6 to 19 months) after the operation. Statistical analysis was based on a test for paired series, patient by patient, with an a risk of 5%. Results: Eight cases of unilateral bladder perforation (21.6%) were treated by catheterization for 48 hours and 6 cases of transient acute urinary retention (16.2%) were also treated by catheterization. No haemorrhagic or infectious complications were observed. Thirty one (83.7%) patients were completely cured of their incontinence, 5 (13.5%) were improved and were was one failure. Six (75%) of the 8 patients with a urethral closing pressure less than 30 cm H2O, 6 were cured and 2 (25%) obtained a marked improvement. All criteria were compared in the same patient preoperatively and postoperatively. The maximum flow rate on uroflowmetry was significantly lower postoperatively, but no difference was observed for preoperative and postoperative detrusor sensitivity, urodynamic bladder capacity or urethral closing pressure. No de novo detrusor instability was observed. Mean severity scores and impact of incontinence scores were much lower postoperatively. Conclusion: The efficacy of TVT does not appear to be correlated with the severity of sphincter incompetence and did not modify the detrusor-sphincter synergy of the patients of our study. The use of a questionnaire appears to be useful and should be recommended in order to more accurately evaluate the efficacy of the surgical procedure and the improvement of the patient's quality of life.