The correlation between preoperative voiding mechanism and surgical outcome of the tension-free vaginal tape procedure, with reference to quality of life

OBJECTIVES: To determine whether the surgical outcome of the tension-free vaginal tape (TVT) procedure differs in patients with dysfunctional voiding (DV) or normal voiding. PATIENTS AND METHODS: The voiding mechanism and surgical efficacy of the TVT procedure were analysed retrospectively by reviewing the charts of 79 consecutive women treated over 2 years. Based on their initial voiding mechanism, the patients were divided into two groups, with or without DV. The King's Health Questionnaire was used to evaluate the women's quality of life both before and 1 year after surgery. RESULTS: The change in free maximum urinary flow rate (Q_max) after surgery differed significantly between the groups (P = 0.001). Moreover, both before and after surgery, the free Q_max was significantly lower (P = 0.019 and 0.001, respectively), and the detrusor pressure at Q_max (both P < 0.001) and urethral resistance (P = 0.036 and 0.027, respectively) significantly higher in the group with DV. The subjective outcome measure showed that the cure rates were not significantly different in the two groups (P = 0.173), but the objective outcome measure showed a significant difference (P = 0.025). Analysis of the total scores for all domains showed that significantly more women improved by > 25% in the group without than in those with DV (P = 0.016). CONCLUSIONS: The objective cure rate of the group without DV undergoing the TVT procedure was significantly higher than in those with DV. In addition, subjective measures assessed by the disease-specific quality-of-life questionnaire indicated that the group without DV had a better quality of life than those with DV.