Treatment results – Unselected data

1. No difference in urinary continence after surgery between retropubic and transobtoratoric transvaginal sling operations when correcting for predisposing factors A Kjaeldgaard, F Taheri-Johansson, M AnkardalDept. Gynecol Obstet, Karolinska and Sahlgrenska University Hospitals and Värnamo County Hospital, Sweden Predisposing factors – Distribution Both urge incontinence and obese are overrepresented in the transobturatoric groups (p< 0.01) Background: Several RCTs report similar treatment results when comparing the two transobturatoric intravaginal tape operations TVT-O and TOT with the original retropubic TVT. Recently reports on the superiority of TVT have been published. How come? M&M: Data from the Swedish National Quality Register on Incontinence Surgery comprising the good 4500 patients included by the end of 2009 were analyzed by groups mentioned below. By the univariate analyses Chi-square test was used. Significance level was p < 0.05. Low risk group: No predisposing factors defined below Risk group: One ore more of the classic predisposing factors preoperative urge incontinence, BMI > 30, history of pelvic floor surgery or hysterectomy and age > 75 years High risk group: All predisposing factors mentioned above Predisposing factors – Treatment resultsHysterectomy is no riskfactor, but age > 75 yy is (p=0.005) Treatment results – Unselected data TVT superior (p<0.002) to both TVT-O and TOT at two months and one year follow-up Riskgroup does matter when it comes to resultsNo difference between the 3 transvaginal methods in the low risk group- but 4 out of 5 patients in clinical practice have some risk factor! Treatment results are impaired (p<0.002) by preoperative urge incontinence Conclusion: Results from RCTs will not predict the outcome in patients with predisposing factors