Hypothesis / aims of study
Urinary incontinence is a very common and debilitating problem affecting about 50% of women at some point in their lives [1]. Mid-urethral tape procedures can be offered for the surgical management of stress urinary incontinence (SUI) and in appropriately selected cases can have a positive impact on improving the quality of life of women with SUI [1]. NICE recommends the use of procedures and devices for which there is high quality evidence of efficacy and safety [2]. Long term outcome data particularly for procedures involving the trans-obturator (TVT-O) approach are currently limited [2]. Studies support that the TVT-O procedure is a safe and efficient treatment of female SUI, with maintenance of high cure rates after a 3-yr minimum follow-up [3]. The aim of this work was to explore patient perceptions of symptoms at long term follow up, following Transvaginal and/or trans-obturator tape repairs for the surgical management of urinary stress incontinence in our unit.
Study design, materials and methods
We retrospectively randomly sampled 45 patients who had undergone transvaginal tape or trans-obturator tape procedures at our local hospital between 2012-2016. Of these, 22 patients responded and consented to participate in a standardised follow up telephone review to follow up on their current clinical symptoms and severity at 3-5 years post surgery. The Telephone reviews were conducted using a ‘cold calling’ technique without prior contact or notification in order to minimise the risk of attrition bias. We determined the presence or absence of symptoms and recorded dichotomous responses as Yes/No. A visual analogue scale (VAS) measured symptom bother and was scored from 1 to 10 to determine if this symptom was better, the same or worse than before the surgery. The severity of symptoms was recorded by measuring patient responses using the Patient Global Impression of Improvement Scale (PGI-I).
Results
Of the cohort of 45 patients, 22 agreed to participate and thus successfully completed the telephone survey. On questioning 55% [n=12] reported leaking urine when coughing, sneezing, straining or when active or exercising. 13% [n=3] reported their symptoms were the same as prior to surgery.
23% [n=5] reported their symptoms of leaking were a little better than prior to surgery. 13% reported their symptoms were much better than prior to surgery. 77% [n=17] reported having to rush to the toilet due to a fear of wetting themselves or leaking. Of which 55% [n=12] reported an improvement since the procedure, 27% felt it was the same as prior to surgery and 27% [n=6] felt it was worse than prior to surgery. 91% reported a history of nocturia of which 27% report this was the same as prior to surgery. 18% n=4 reported this as very much better than prior to surgery and 18% reported this as very much worse. 68% reported difficulty in emptying their bladder completely when voiding. 23% of people required further surgery since their primary surgery due to symptoms, reoccurrence or worsening of symptoms. 50% reported pain during intercourse and 36% reported leg or groin pain following surgery. 36% reported a lump or bulge sensation in the vagina of which 32% reported had not changed since having the surgery. 23% [n=5] went on to require further operations for urinary incontinence or tape erosion following their primary procedure. Overall 86% [n=19] were satisfied with the results of their operation and 59% [n=7] would recommend it to a friend or family member.
Interpretation of results
Our study suggests, 55% reported leaking on coughing, exercising or sneezing, 77% had urgency, 91% nocturia, 68% reported difficulty emptying their bladder. 23% required revision or further surgery following their primary operation. Our results albeit a small sample size, are in keeping with similar studies suggesting TVT-O and TVT can be effective in the short and medium term however, further evidence is required to see the long term benefits and reoccurrence rates [1].