Effect of tension-free vaginal tape in women with a urodynamic diagnosis of idiopathic detrusor overactivity and stress incontinence

Objective To determine the effect of tension-free vaginal tape (TVT) in women with idiopathic detrusor overactivity (DO) and urodynamic stress incontinence (USI) and to propose appropriate pre-operative counselling based on this information. Design Retrospective cohort study. Setting Urogynaecology Unit, District General Hospital, Kent. Population Fifty-one women (from a total of 344 women undergoing TVT) with urodynamic evidence of both DO and USI who underwent TVT insertion between November 1999 and March 2003. Methods Women with more than six-month follow up were assessed objectively with cystometry. Subjective results were assessed using structured interview and condition specific Kings Quality of Life Questionnaire. Main outcome measures Objective resolution of DO and subjective absence of urge syndrome after TVT. Cure of USI was the secondary outcome measure analysed. The effect of drug therapy on residual urge symptoms was assessed. Results Objective cure of DO was demonstrated in 47% and subjective cure of urge symptoms in 63%. In women with persistent urge symptoms, the addition of anticholinergic medication resulted in resolution of urge incontinence in a further 22% of women. USI was objectively cured in 92%. Conclusions More than 60% of women diagnosed urodynamically with DO and USI experience complete resolution of urge symptoms following TVT. Further symptom improvement can be achieved with additional anticholinergic medication.