The tension-free vaginal tape in women with a non-hypermobile urethra and low maximum urethral closure pressure

The objective of this study was to estimate the cure rate and to identify risk factors that predict failure of the tension-free vaginal tape (TVT) in women with stress urinary incontinence (SUI), a non-hypermobile urethra, and low maximum urethral closure pressure. Thirty-six women with SUI, a non-hypermobile urethra (straining urethral angle ≤35°), and low maximum urethral closure pressure (MUCP ≤25 cm H₂O) underwent a TVT. Cure was defined as resolution of subjective SUI symptoms and a negative cough stress test, which were measured after 4, 12, 18, and 24 months. Patient characteristics were compared and receiver–operator curves were used to identify risk factors for failure. The mean age was 71 years, and mean follow-up was 20.9 months. The overall cure rate was 78%. Risk factors for failure of the TVT were a straining urethral angle ≤20° (cure rate 50%, odds ratio 7.7, p = 0.02) and a MUCP ≤15 cm H₂O (cure rate 60%, odds ratio 6.3, p = 0.03). For women with both risk factors, the cure rate was only 17% (p < 0.001). No other risk factors were identified. The TVT has moderate success (50-60%) for women with SUI and one risk factor (a straining urethral angle </=20 degrees or a MVCP </=15 cm H₂O), but has poor success (17%) when both risk factors are present.