OC18.04: Are voiding difficulties associated with tape location 10–20 years after tension free vaginal tape surgery?

The aim was to study potential differences in incontinence symptoms, anterior compartment descent and tension free vaginal tape (TVT) location 10 – 20 years after surgery between women with and without subjective and objective voiding difficulties. Cross-sectional study in 2022 of 263 women with TVT surgery in 2001-2012. A validated questionnaire grading stress (0-12) and urgency (0-8) incontinence symptoms was used. We used ultrasound to measure the TVT-distance from the bladder neck at rest and from the symphysis at Valsalva. Bladder neck and bladder descent in relation to the symphysis were measured at Valsalva. Differences in incontinence symptoms, TVT location and bladder descent were compared between women with and without subjective voiding difficulties and between women with and without post void residual urine > 200ml (independent samples t-test). Mean (SD) age was 62.1 (11.9) years, BMI 26.5 (4.6) kg/m2 and time since surgery 16.4 (4.5) years. The 45.0% (117/260) women reporting voiding difficulties had higher stress incontinence index (2.9 vs 2.1, p = 0.03) and urgency index (3.0 vs 2.3, p = 0.01) than women without subjective voiding difficulties. No difference in TVT-distance from bladder neck or symphysis was found (1.7 vs 1.7 mm, and 1.0 vs 1.1 mm, p > 0.05), and descent of bladder and bladder neck were similar in both groups (-0.04 vs -0.3, and -0.92 vs -1.02cm, p>0.05). 11.1% (24/217) had residual volume > 200ml. They had higher urgency incontinence index than women with less residual (3.5 vs 2.5, p = 0.029), but no differences in TVT location, descent of bladder or bladder neck. Descent of anterior compartment and TVT-location were not associated with voiding difficulties or high post-void residuals 10-20 years after surgery. Women stating voiding difficulties had higher stress- and urgency incontinence scores than women without voiding difficulties, and women with post-void residual >200ml had higher urgency incontinence scores than women with less residual urine.