Transcript Document

No difference in urinary continence after surgery between retropubic and transobtoratoric
transvaginal sling operations when correcting for predisposing factors
A Kjaeldgaard, F Taheri-Johansson, M Ankardal
Dept. Gynecol Obstet, Karolinska and Sahlgrenska University Hospitals and Värnamo County Hospital, Sweden
Background: Several RCTs report similar treatment results when comparing the two
Predisposing factors – Distribution
transobturatoric intravaginal tape operations TVT-O and TOT with the original retropubic TVT.
Recently reports on the superiority of TVT have been published. How come?
Both urge incontinence and obese are overrepresented in the transobturatoric groups
(p< 0.01)
Urge Incontinence preop
Operation (almost) > once a
type
never
week
TVT
*43.0%
57.0%
TVT-O
37.9%
62.1%
TOT
40.2%
59.8%
mean
41.3%
58.7%
BMI
Total
2299
1008
605
4012
Operation
type
TVT
TVT-O
TOT
mean
<30 30-35
79,9% 15,7%
74,7% 18,5%
77,4% 17,0%
78,3% 16,6%
>35 Total
4,4% 2364
6,8% 976
5,6% 593
5,2% 3933
Predisposing factors – Treatment results
Hysterectomy is no riskfactor, but age > 75 yy is (p=0.005)
Treatment results – Unselected data
TVT superior (p<0.002) to both TVT-O and TOT at
two months and one year follow-up
Operation
type
TVT
TVT-O
TOT
mean
Urinary leakage 8 w
Continent
74,4%
71,5%
70,8%
73,1%
Once a Leakage
week
daily
Total
14,0% 11,6% 1254
14,7% 13,8%
523
13,7% 15,6%
315
14,1% 12,8% 2092
Treatment results are impaired (p<0.002)
by preoperative urge incontinence
Operation
type
TVT
TVT-O
TOT
mean
Urinary leakage 1 y
Once a
Continent week
70,5% 17,1%
60,6% 21,4%
65,7% 16,5%
67,3% 18,1%
Leakage
daily
12,4%
18,0%
17,8%
14,6%
Total
1254
523
315
2092
Previous hysterectomy in low risk group
Urinary leakage after 8 weeks
previous
Once a leackage
hysterectomy
Continent
week
daily
Total
No
87,8%
8,9%
3,2%
831
Yes
86,7%
7,6%
5,7%
105
Age-related results in low risk group
Age (years)
% postop continent
<35
91.7
35-45
90.7
45-55
87.5
55-65
86.6
65-75
87.9
>75*
70.4
Riskgroup does matter when it comes to results
Urge
incontinence
preop
Never
Almost never
1-3 times a
month
1-3 times a
week
Daily
mean
patients
included
Postop continence
No difference between the 3 transvaginal methods in the low risk group
- but 4 out of 5 patients in clinical practice have some risk factor!
1y
8w
86,6%
86,1%
80,5%
83,5%
79,6%
75,2%
70,6%
61,5%
58,9%
72,5%
3282
55,3%
67,2%
Treatment results - low risk
Urinary leakage after 8 weeks
Operation
Once a Leakage
Continent
type
week
daily
Total
TVT
88,5%
8,8%
2,7% 524
TVT-O
85,2%
10,4%
4,4% 183
TOT
88,7%
7,3%
4,0% 124
mean
87,8%
8,9%
3,2% 831
treatment results- high risk group
Urinary leakage after 8 weeks
Operation
Once a
type
Continent
Leakage daily
week
Total
TVT
48,4% 22,0%
29,7%
91
TVT-O
51,2% 20,9%
27,9%
43
TOT
68,4% 5,3%
26,3%
19
mean
51,6% 19,6%
28,8%
153
1943
Conclusion: Results from RCTs will not predict the outcome in patients with predisposing
factors