The tension-free vaginal tape in older women


Dr E. Karantanis, Pelvic Reconstruction and Urogynaecology Unit, Department of Obstetrics and Gynaecology, St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK.


Objective  To evaluate peri-operative morbidity, continence outcome and patient satisfaction in older women (≥65 years) compared with younger women undergoing tension-free vaginal tape.

Design  Case controlled study.

Setting  Tertiary Urogynaecology Unit.

Sample  Women undergoing tension-free vaginal tape for urodynamic stress incontinence between July 1999 and July 2002 were included. Those with detrusor overactivity, voiding difficulty at urodynamics or requiring concomitant prolapse surgery were excluded.

Methods  Older women were case matched to a younger cohort for BMI, parity, mode of anaesthesia and whether it was a primary or secondary continence procedure.

Main outcome measures  Operative morbidity and continence outcome were assessed at six weeks. After a minimum six months follow up, patient satisfaction and continence outcome were assessed using the Genitourinary Treatment Satisfaction Score (GUTSS).

Results  The median hospital stay was one day and overall urinary tract infection rate was similar in both groups. Post-operative voiding difficulty rates were 3% in older versus 15% in younger women (P= 0.09). At six weeks, 65% of older versus 79% of younger women were dry (P= 0.2). At a median of 12 months, 15 (45%) of older versus 24 (73%) of younger women had no urinary symptoms (P= 0.05). Median GUTSS scores for satisfaction with continence outcome were lower for older 90% compared with 100% in younger women (P= 0.003).

Conclusions  Tension-free vaginal tape is an effective continence intervention in older women but has a lower continence satisfaction rate compared with younger women.