The efficacy and complications of retropubic tension-free vaginal tapes after 20 years: a prospective observational study

Objective: Long-term data regarding risks associated with tension-free vaginal tapes (TVT) are sparse, and where available are limited to small numbers. We analyse patient-reported outcomes of TVT after 16–24 years. Design: Prospective observational study. Setting: Single-centre study in a tertiary referral urogynaecology unit. Population: A cohort of 350 women who had a TVT inserted between 1999 and 2004, in which 96% had urodynamically proven stress incontinence. Methods: Postal questionnaire survey using the International Consultation on Incontinence Questionnaire, a visual analogue scale and a yes/no question as to whether they would have the procedure again. Main outcome measures: The primary outcome was cure of stress urinary incontinence, which was assessed using the ICIQ-FLUTS questionnaire. Secondary outcomes included overactive bladder symptoms, pain, sexual dysfunction, and patient satisfaction with the procedure. Results: A total of 183/350 (52%) responses were received. The median age of women at follow up was 67 years (range 53–93 years) and the median follow up was 20 years (17–24 years). Stress urinary incontinence was denied by 39.3% of women. Urgency was reported by 42.1%. Bladder pain was reported either ‘never’ or ‘occasionally’ by 92.3% of women. The median satisfaction rate was 98/100 and 92.4% said they would have the TVT procedure again. Conclusions: Tension-free vaginal tape has high levels of satisfaction and cure up to 24 years after placement. Pain was uncommon and its impact on quality of life was low. Symptoms of urgency were prevalent but may be related to age. TVT is an effective treatment for SUI more than 20 years after initial placement.