Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence G. Che ˆne * , J. Amblard, A.S. Tardieu, J.R. Escalona, A. Viallon, B. Fatton, B. Jacquetin Urogynaecology Unit, Maternity Ho ˆtel-Dieu, Clermont-Ferrand University Hospital, 11 Boulevard Le ´on Malfreyt, 63058 Clermont-Ferrand Cedex 1, France Received 2 December 2005; received in revised form 11 May 2006; accepted 13 June 2006 Abstract Objectives: Prospective evaluation of outcome and complications over a 5-year period post-treatment of urinary stress incontinence by TVT, and comparison of our results with the reference studies. Materials and methods: About 94 patients were treated for urinary stress incontinence only by one TVT procedure (single surgical procedure), between April 1997 and December 1998; 68% of patients presented pure urinary stress incontinence and 32% mixed incontinence. We found also a 25.5% rate of sphincter deficiency (UCP < 20 cm H 2 O) in this cohort. Patients were evaluated after 5 years: 52 complete evaluations (clinical, flow measurement with measurement of post-mictional residue, 24 h PAD-test, quality of life questionnaire), 30 complete telephone interviews, 12 lost to follow-up (2 patients deceased). Results: About 87% of the patients had a 5-year follow-up. The success rate was 79.2% overall (84.5% for the pure urinary stress incontinence and 67% for the mixed incontinence cases), and 72.2% for the cases of associated sphincter deficiency. We had only a 13% rate of patients lost to follow-up. More than half of the urinary urgency cases were treated successfully, however with a less satisfactory outcome in cases of bladder instability. The urodynamic exploration appeared to reveal that TVT caused dysuria: 52% of patients had a maximum flowrate below 15 ml/s, but the quality of life was improved, with a 95% rate of satisfaction without functional problems. We observed no late complications such as vaginal erosion or rejection of the prolene; the de novo syndrome was rare, with 8.5% of urinary frequency, 6% of urinary urgency and only 5.7% of invalidating dysuria. We saw no cases of pelvic floor disease after TVT treatment. Discussion: Our casuistry results are comparable with the reference studies by Scandinavian authors, Rezapour and Ulmsten, confirming the long-term success of the TVT procedure. Concerning the apparently elevated rates of post-TVT dysuria found by urodynamic exploration, a distinction has to be drawn between post-TVT urinary problems (frequent but oligosymptomatic), and true, severe dysuria (rare). However, ‘‘dysuria’’ in the broad sense did not affect the patients’ quality of life, and is a reminder of the absolute necessity of meticulous compliance with the correct surgical techniques. Conclusion: Treatment of urinary incontinence by TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications; it is inexpensive and very successful, including in complicated cases such as sphincter deficiency. All the recent data confirms, with this 5-year follow-up, that the TVT procedure is comparable to the previously gold standard, the Burch colposuspension. # 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: TVT; Long-term results; Urinary incontinence; Complications 1. Introduction Urinary stress incontinence is a real public health problem and concerns 77–91% of women suffering from incontinence. The frequency is 37% after 18 years of age, and can be expected to increase with the general aging of the population [1]. www.elsevier.com/locate/ejogrb European Journal of Obstetrics & Gynecology and Reproductive Biology 134 (2007) 87–94 * Corresponding author at: Le Grand Pavois, 35, rue Gonod, 63000 Clermont-Ferrand, France. Tel.: +33 6 07 08 17 86; fax: +33 4 73 75 01 57. E-mail address: chenegautier@yahoo.fr (G. Che ˆne). 0301-2115/$ – see front matter # 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2006.06.009