Commented Abstracts
Outcome measures after TVT for mixed urinary incontinence.

Sinha D
, Blackwell A, Moran PA.  
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Feb 5
This study assessed the outcome of tension-free vaginal tape (TVT) in the treatment of mixed incontinence using the Medical Epidemiologic and Social Aspects of Ageing (MESA) questionnaire and other outcome measures used by the British Society of Urogynaecology (BSUG) database. Forty women undergoing TVT completed a MESA questionnaire pre-operatively and at 6 months post-operatively. Information was also obtained about three outcome measures of the BSUG database-patients' global impression of outcome and stress and urge symptom analyses. Stress and urge incontinences were either cured or improved in 78 and 75 % of women, respectively, after TVT. The results of post-operative patients' global impression of outcome showed great or moderate improvement in 75% of cases and had 69% reduction in mean MESA scores (p value less than 0.001). Symptom improvement based on MESA scores relates well with the basic outcome measures for stress and urge incontinences used by the BSUG database.

Editor’s comment

Detrusor hyperactivity (DH) is considered a risk factor for failure or reduced success in the surgical treatment of urinary incontinence. The study’s strong points are its prospective design, and the use of validated self-administered questionnaires before and 6 months after surgery. The weak points include the relatively small sample size and the fact that no postoperative objective evaluation was performed. Detrusor hyperactivity response to surgery was assessed using several techniques. Satisfaction rates (DH improvement or cure) ranged from 50% to 75%. Regarding the indication of surgery to this subgroup of patients, two aspects are critical: to assess the intensity of urge incontinence symptoms (when urge symptoms predominate over stress symptoms, failure is more likely to occur), and, whenever possible, to initially offer conservative treatment associated with local hormone replacement therapy if needed, pelvic exercises/electrostimulation and anticolinergics. Should conservative treatment fail, it is very important that surgery candidates are aware of the limitations of the surgical methods related with severe DH symptoms.

Aparecido Donizeti Agostinho