The Real Impact of De Novo Bladder Dysfunction After Transvaginal Tension-Free Vaginal Tape-Obturator (TVT-O): A Prospective Study.

Introduction

Transobturator midurethral slings (MUSs) are commonly used to treat female stress urinary incontinence (SUI). Despite their high success rates, postoperative complications such as voiding dysfunction (VD) and de novo overactive bladder (OAB) symptoms may affect quality of life (QoL). This study aims to evaluate patient-reported outcomes regarding bladder dysfunction (VD and OAB) and SUI resolution.

Methods

Patients undergoing transvaginal tension-free vaginal tape-obturator (TVT-O) for SUI without detrusor overactivity were enrolled from April 2018 to April 2023. Final 12-month follow-up was completed in April 2024. Follow-up at 6 and 12 months included physical examination, stress tests, and a 3-day voiding diary. The Urinary Symptom Profile (USP) questionnaire was administered at 12 months. A VAS score evaluated the subjective bother of voiding dysfunction. Objective cure was defined as a negative stress test at follow-up. Changes in daily leakage episodes were assessed using the 3-day voiding diary.

Results

Ninety-two patients were enrolled, of whom eight-nine completed the 6- and 12-month follow-up and were included in the final analysis. The objective cure rate was, respectively, 93% at 6 months and 89% at 12 months. The USP questionnaire administered at 12 months showed that the SUI domain score was 0 in 80.9% of patients. De novo urgency was reported in 44% of patients. Urge incontinence and nocturia occurred, respectively, in 33% and 8% of patients. Patient-reported voiding symptoms, defined as LS ≥1, were observed in 58.4% of patients. Among patients with LS ≥1, 38/52 (73.1%) reported tolerable bother (VAS < 5), whereas 14/52 (26.9%) reported clinically important or intolerable bother (VAS ≥5).

Conclusions

TVT-O was associated with a high objective cure rate; however, patient-reported OAB and voiding symptoms were common at 12 months. These findings support a more comprehensive informed consent process for patients undergoing TVT-O surgery in order to increase patient awareness of the potential development of OAB and VD following the surgical procedure.