BERKELEY, CA (UroToday Inc.) - Since the introduction of the tension-free vaginal tape (TVT) by Ulmsten and colleagues in 1996, it has become one of the most commonly performed procedures for the treatment of stress urinary incontinence (SUI). As it continues to be more widely used, David Gordon and colleagues from Tel Aviv, Israel performed a study to determine the efficacy and safety of the procedure in older women as compared to younger women. Their results were published in the March 2005 edition of Urology.

They studied 460 consecutive women undergoing TVT surgery for SUI. Those women ≥ 70 years old were considered "elderly", and those < 70 years old were considered "younger". All patients underwent preoperative and three month postoperative urodynamic studies. Patients had close monitoring during the postoperative period in order to document any surgery or age related morbidity. Follow up evaluation included a one hour pad test, uroflow, post void residual, and limited physical exam at 1, 3, 6, and 12 months and annually thereafter.

Their study consisted of 157 elderly women and 303 younger women. 4.6% of patients had undergone previous continence surgery. On preoperative urodynamics, all patients had documented SUI. 31% of elderly patients versus 23% of younger patients (p < 0.05) had mixed urinary incontinence.

Most women who had a TVT only were discharged on the same day as the operation. Vaginal prolapse repair was performed at the same setting in 84% of elderly women and 67% of younger women. Mean hospital stay was 5.6 ± 3.2 versus 4.3 ± 2.4 days in the older and younger women respectively.

The two groups had similar incidences of postoperative fever, urinary tract infection, hematoma formation, wound infection, and blood loss. However, in the elderly group, there were some significant additional morbidities including: pulmonary embolism (2), cardiac arrhythmia (2), severe pneumonia (1), and deep vein thrombosus (1).

Both groups had similar rates of TVT complications except for higher rates of bladder perforation occurring in the younger patients (4.9%) than in the older patients (1.3%). Younger patients also had a higher incidence of postoperative voiding problems that required catheterization > 7 days (4.3% versus 2.5%). All began voiding spontaneously by one month except for one who was treated successfully with a transvaginal excision of the TVT and subsequent urethrolysis. Vaginal mesh erosions occurred in 1.9% and 1% of the older and younger women, respectively.

Outcome analysis was performed only on those women who had at least 1 year of follow up (mean 30 ± 12 months). 123 elderly and 208 younger women met this criterion. Both groups had similar rates of persistent SUI (7% elderly vs. 6% younger), urge incontinence (75% elderly vs. 76% younger) and bladder outlet obstruction (1.6% elderly vs. 1.4%younger). De novo urgency was significantly more common in elderly women than in younger women (18% vs. 4%).

The authors conclude that the TVT procedure can be performed safely in elderly women with outcomes similar to those in younger women. However, elderly women should be counseled about the increased risk of postoperative de novo urgency, as well as the possibility of significant age-related morbidity.

Urology 2005; 65:479-482