Objective: The objective of this article is to estimate results and place of TVT in female stress urinary incontinence with intrinsic sphincter incompetence.
Material and method: This was a retrospective study over a period of 57 months in a population of 38 patients treated by TVT for sphincter incompetence with or without inefficient pressure transmission. Mean patient age was 52 years. Fourteen patients (37%) had a history of incontinence surgery. The physical examination demonstrated urethral mobility in 22 patients (58%) and positive Bonney or Jacquetin tests in 15 patients (39%). Mean maximum urethral closure pressure was 40 cm H2O, with 12 patients (32%) 30 cm. Six patients (16%) had detrusor instability. Seven patients (18%) had pure sphincter incompetence.
Results: Median follow-up was eight months (two months to 32 months). Twenty five patients (66%) were cured, nine (24%) improved and treatment failed in four (10%). Results are less satisfactory for patients with preliminary failure of incontinence surgery, fixed urethra, pure sphincter incompetence or with detrusor instability without inefficient pressure transmission. The only major complication was an expulsion of the prosthesis.
Conclusion: Results of TVT in sphincter incompetence are slightly less satisfactory than in pure urinary stress incontinence. In a short follow-up, they are comparable in sphincter incompetence to those of sling procedures which are the current gold standard. Risk of urinary retention is lesser. The minimally invasive nature of TVT suggests that it will replace sling procedures in the future for this particular indication. Longer follow-up will be necessary for confirmation.