Patient satisfaction with operative outcomes following mid-urethral tape surgery for stress urinary incontinence

Sambandan N1, Nair R1

Research Type

Clinical

Abstract Category

Quality of Life / Patient and Caregiver Experiences

Abstract 605
Open Discussion ePosters
Scientific Open Discussion Session 28
Friday 31st August 2018
13:10 - 13:15 (ePoster Station 12)
Exhibition Hall
Stress Urinary Incontinence Quality of Life (QoL) Surgery Pelvic Floor Overactive Bladder
1. Queen's Hospital, Barking, Havering and Redbridge NHS Trust
Presenter
N

Nikola Sambandan

Links

Poster

Abstract

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].
Concluding message
Overall patients appear to be satisfied with the results of their operation however, longer term they report and attribute reoccurrence or worsening of predominantly overactive bladder (OAB) symptoms, 12-24 months after the procedure. In our cohort, 86% were satisfied with the results of their primary operation and 59% would still recommend the surgery to a friend or relative at 3-5 years post intervention. Further studies, with a larger sample size are required to confirm long term benefits and reoccurrence of symptoms following mid-urethral tape surgery.
References
  1. Ford A et al, 2015. Mid-urethral sling operations for women. Cochrane Database of Systematic Reviews.
  2. National Institute of Health and Care Excellence (NICE), 2014. Urinary Incontinence in women: management. London: NICE.
  3. TVT-O for the Treatment of Female Stress Urinary Incontinence: Results of a Prospective Study after a 3-Year Minimum Follow-Up. Waltregny, David et al. European Urology, Volume 53, Issue 2, 401 - 410
Disclosures
Funding None Clinical Trial No Subjects Human Ethics not Req'd Patients volunteered and had informed consent to make a decision to partake in this anonymous study. Helsinki Yes Informed Consent Yes
28/03/2024 07:06:17