Stress incontinence subtypes respond to TVT. (Cough Stress Test Not Necessary).

SAN FRANCISCO -- Results from separate studies of tension-free vaginal tape suburethral slings suggest that the procedure improves all five subtypes of stress urinary incontinence.

Moreover, patients don't necessarily have to be awake to do a cough stress test during the procedure to get good results, investigators reported at the annual meeting of the American Urogynecologic Society.

The tension-free vaginal tape (TVT) suburethral sling is predominantly used to treat patients with anatomic stress urinary incontinence, typically defined as a change of less than 30 degrees on the "Q-tip" angle test. A retrospective study of 267 patients who underwent a TVT procedure found that the TVT sling also is effective in patients with varying degrees of intrinsic sphincter deficiency, minimal urethral hypermobility, or occult incontinence, Dr. Jeffrey L. Segal reported in a poster presentation at the meeting.

All patients had symptoms of urinary incontinence or pelvic organ prolapse, and 80% of them underwent a concomitant reconstructive pelvic procedure at the time of TVT insertion. All had been diagnosed with genuine stress urinary incontinence by multichannel urodynamics; the investigators subdivided patients into five categories.

The procedure cured 84% of 121 patients with isolated anatomic stress urinary incontinence and 75% of 22 patients with isolated intrinsic sphincter deficiency, defined by a urethral closure pressure of less than 20 cm of water or a leak point pressure of less than 60 cm of water.

Among 32 patients with combined anatomic stress urinary incontinence and intrinsic sphincter deficiency, 81% were cured by TVT, said Dr. Segal of Good Samaritan Hospital, Cincinnati.

The TVT sling cured 84% of 25 patients without intrinsic sphincter deficiency who had a well-supported bladder neck and 82% of 67 patients with occult urinary incontinence, defined as stress urinary incontinence that appeared only after the prolapse was reduced.