BERKELEY, CA (UroToday Inc.) - An estimated 35% of community dwelling elderly women suffer from urinary incontinence, with the incidence increasing with age. Incontinence has been shown to affect the psychological, occupational, domestic and sexual lives of 15 to 30% of women of all ages. Urologists have been searching for a minimally invasive procedure for the elderly woman who may suffer from multiple co-morbidities but is bothered by stress urinary incontinence.

The tension-free vaginal tape (TVT) procedure was introduced in 1993 and has produced excellent success rates in between 80% and 90% of patients at 5 years of follow-up. The mid-urethrally placed tape reinforces the pubourethral ligaments and helps restore continence. The fundamental aim of any stress incontinence treatment is to improve quality of life.

A prospective study using a sensitive, disease specific, validated questionnaire was performed to examine the outcome of the TVT procedure in cohorts of both younger (less than 70 years) and older (greater than 70 years) women. K. Walsh et al from University of California, Davis, described the results and reported them in the March, 2004 issue of the Journal of Urology.

Sixty-seven patients with genuine stress urinary incontinence underwent treatment with a tension-free vaginal tape procedure. Forty-six patients were younger than 70 years old (mean 54) and twenty-one patients were 70 years or older (mean 76). Quality of life was assessed via the validated Kings Health Questionnaires. Both the impact of urinary symptoms on life and the female perception of general health were ascertained from the questionnaires. Mean follow-up was 9 months for the younger group and 12 months for the group older than 70.

Results showed that the rate of immediate, spontaneous postoperative voiding was the same in each group (57%). All patients except two resumed voiding within 7 days. Stress incontinence was improved in 91% of the younger group and in 80% of the older group. Statistically significant improvement was observed in most quality of life domains and symptom scores in the two groups. This was sustained for at least 9 months. More marked improvement was seen in the younger group.

Although tension-free vaginal tape is a relatively new procedure for stress urinary incontinence, it has been introduced rapidly into practice. Elderly patients showed marked improvement in continence despite the fact that they often had more comorbidity and a greater likelihood of failed previous incontinence surgery. Older patients tolerated the procedure well and demonstrated substantial changes in quality of life outcomes, suggesting that this procedure is a safe and effective option for the elderly patient.

J Urol 2004;171:1185-88.