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Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion

Edyta Wlaźlak, Volker Viereck, Jacek Kociszewski, Andrzej Kuszka, Oliver Rautenberg, Claudia Walser, Grzegorz Surkont, Marianne Gamper & Mathias K Fehr

abstract

AIMS
Intrinsic sphincter deficiency (ISD) is a known risk factor for therapy failure after tension-free vaginal tape (TVT) insertion. The purpose of this study was to investigate if the severity of ISD alone or other factors such as urethral mobility and tape localization influence outcomes.

METHODS
One hundred and nine women with urodynamically determined ISD, a TVT insertion, and a 6-month follow-up visit were included. Urethral length, mobility, and tape localization were evaluated by pelvic floor sonography. Patients were classified into three urethral mobility groups (hypomobile, normomobile, hypermobile). Surgical outcome was assessed by a combination of objective and subjective criteria.

RESULTS
Therapeutic success rate after TVT insertion was 81.6%. The severity of ISD did not associate with therapy failure. But urethral mobility (P < 0.0001), relative tape position (P = 0.0003), and tape-urethra distance (P < 0.0001) differed between cured and not cured patient groups. Patients with a relative tape position toward 1/2 of urethral length had a higher cure rate. Significantly different cure rates (P = 0.0003) were found for hypomobile (67%), normomobile (76%), and hypermobile (100%) urethras. For ISD patients with a hypomobile urethra, highest cure rates were obtained for tape-urethra distances between 2.5 and 3.5 mm.

CONCLUSIONS
The reduced cure rate for ISD patients was due to the subgroup with a hypomobile urethra. A prospective study is needed to confirm that slightly shorter tape-urethra distances and a relative tape position more toward the mid-urethra will lead to better outcomes for this patient group.
   
citation Wlaźlak E, Viereck V, Kociszewski J, Kuszka A, Rautenberg O, Walser C, Surkont G, Gamper M, Fehr M K. Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion. Neurourol Urodyn 2017; 36:1910-1916.
   
type journal paper/review (English)
date of publishing 31-1-2017
journal title Neurourol Urodyn (36/7)
ISSN electronic 1520-6777
pages 1910-1916
PubMed 28139863
DOI 10.1002/nau.23211
contact Oliver Rautenberg