Does the tension‐free vaginal tape procedure affect the voiding phase? Pressure‐flow studies before and 1 year after surgery

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Abstract
Objective To evaluate the voiding phase before and 1 year after surgery in women who underwent a tension‐free vaginal tape (TVT) procedure for stress incontinence. Patients and methods The study comprised 45 women with genuine stress urinary incontinence. To assess the voiding phase, patients were asked if their voiding had changed after surgery, and objectively the uroflowmetry, residual urine measurements and pressure‐flow data were compared. Results At 1 year after surgery 39 women (87%) were subjectively cured and six (13%) improved. The objective cure rate was 88%; the pad‐test leakage and the number of leakage episodes decreased significantly after surgery. Subjectively, 78% of the patients reported that the voiding phase had become more difficult, and the spontaneous flow curve changed to a more obstructive pattern in 40%, with the mean urinary peak flow rate (Qmax), the corrected Qmax and the mean average flow rate decreasing significantly. The residual urine volume increased significantly, although no patient had volumes of > 25% of their bladder capacity. During the pressure‐flow study the Qmax decreased and the urethral resistance factor increased significantly. However, only one patient could be classified as obstructed. Two patients had clinical problems and used self‐catheterization once daily 1 year after surgery. Conclusion There were subjective and objective changes in the voiding phase 1 year after the TVT procedure. The significance of these findings remains to be determined. Longitudinal studies are warranted to clarify whether the patients at risk can be characterized from subjective and objective findings.