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Warn About Risk of Irritative Bladder Symptoms After TVT


 

MONTREAL — Patients undergoing tension-free vaginal tape procedures for stress urinary incontinence should know that although their quality of life will likely improve after the surgery, about one-fifth of them may experience postoperative irritative bladder symptoms, according to a Dutch expert.

In a study of 307 women undergoing a tension-free vaginal tape (TVT) procedure, 19% reported irritative bladder symptoms postsurgery, said Steven Schraffordt, M.D., of the Meander Medical Centre in Amersfoort, the Netherlands.

“All patients showed an improvement in quality of life … [but] … no specific [preoperative or operative] factors could be identified for changes in irritative symptoms after TVT,” he reported at the annual meeting of the International Continence Society.

Until now, the rate of irritative bladder symptoms after TVT procedures has been difficult to determine because previous studies have not controlled for patients who have undergone concomitant surgery, said Dr. Schraffordt. His study selected women who were being treated for stress urinary incontinence (SUI) alone and who had received no previous urogynecologic surgery or medications for bladder symptoms.

The multicenter prospective study required patients to answer two questionnaires prior to surgery and again 36 months later. The Urogenital Distress Inventory (UDI-6) measures stress incontinence and irritative and obstructive discomfort, while the Incontinence Impact Questionnaire (IIQ-7) measures the implications of urinary incontinence for normal daily functioning.

Three years postsurgery, 59 of the 307 patients (19%) reported irritative symptoms in response to the question: “Do you experience, and if so, how much are you bothered by: frequent urination and leakage related to feelings of urgency?” However, no preoperative or intraoperative differences could be identified between this group and the remaining 248 (81%) patients who reported no irritative symptoms.

Even those who reported worsened irritative symptoms had significantly improved quality of life scores on the IIQ-7, with a drop from preoperative score of 50.96 to postoperative score of 23.7. Patients who did not experience irritative symptoms had a more dramatic quality of life improvement with a preoperative QII-7 score of 59.3, which dropped to a postoperative score of 10.7. A comparison of both groups found a significantly greater improvement in the nonirritative patients.

“It is impossible to predict preoperatively which patient is more at risk for developing irritative symptoms after a TVT,” he commented. “Patients should therefore be informed preoperatively about the risk of developing these symptoms.”

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