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Obstetrics & Gynecology 2004;104:42-49
© 2004 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Tension-Free Vaginal Tape and Laparoscopic Mesh Colposuspension for Stress Urinary Incontinence

Antti Valpas, MD, Aarre Kivelä, MD, PhD, Jorma Penttinen, MD, PhD, Erkki Kujansuu, MD, PhD, Mervi Haarala, MD, PhD and Carl-Gustaf Nilsson, MD, PhD

From the Central-Ostrobothnian Central Hospital, Kokkola; Oulu University Hospital, Oulu; Kuopio University Hospital, Kuopio; Tampere University Hospital, Tampere; Turku University Hospital, Turku; and Helsinki University Central Hospital, Helsinki, Finland.

Address reprint requests to: Antti Valpas, Department of Obstetrics and Gynecology, Central-Ostrobothnian Central Hospital, Mariankatu 16–20, FIN-67200 Kokkola, Finland; e-mail: antti.valpas{at}kolumbus.fi.

OBJECTIVE: To compare objective and subjective outcomes after the tension-free vaginal tape procedure (TVT) with laparoscopic mesh colposuspension as a primary treatment for female stress urinary incontinence. Objective outcome measures were stress test and 48-hour pad test.

METHODS: In 6 departments of gynecology in Finland, including 4 university teaching hospitals and 2 central hospitals, 128 women with urodynamic stress incontinence were randomly allocated to 2 treatment groups. Seventy were treated with TVT and 51 by means of laparoscopic mesh colposuspension. There were 7 dropouts. Inclusion criteria were history of stress incontinence, positive stress test, and urodynamic conformation of stress incontinence. Exclusion criteria were age older than 70 years, previous incontinence surgery, more than 3 episodes of urinary tract infection within the last 2 years, coincident other gynecological surgery, body mass index more than 32 kg/m2, urethral closure pressure less than 20 cm H2O, and residual volume more than 100 mL in preoperative urodynamic evaluation. Assessment took place before treatment and at 12 months postoperatively with the cough stress test, Urge Score, 48-hour pad test, King's College Health Questionnaire, Visual Analog Scale, and Urinary Incontinence Severity Score.

RESULTS: When negative stress test was used as criteria for cure, 85.7% of women in the TVT group and 56.9% in the laparoscopic mesh colposuspension group were objectively cured. Subject satisfaction was significantly better after the TVT procedure than after laparoscopic mesh colposuspension.

CONCLUSION: Treatment with TVT results in higher objective and subjective cure rates at 1 year than treatment by means of laparoscopic mesh colposuspension.

LEVEL OF EVIDENCE: I






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