Authors' objectives:

This study aims to review the effectiveness and cost-effectiveness of tension-free vaginal tape (TVT) for stress urinary incontinence (SUI) in women.

Authors' recommendations: Clinical: SUI mainly affects women 40 and over. Improved quality of life is the primary treatment outcome for women with severe SUI. There are a variety of treatment options for women with SUI. SUI should initially be managed using conservative treatments as outlined by clinical guidelines, because most women respond to these treatments. When conservative treatments fail, TVT could be considered as an alternative to currently used surgical procedures for women with SUI who are past the childbearing age. TVT should not be used as an alternative to conservative therapies. Effectiveness and procedure-related complications are dependent on surgical training. While cure rates of TVT are similar to that of colposuspension (the current gold standard for surgical treatment of SUI) in clinical trials, follow-up longer than two years has not been effectively examined. Perioperative complication rates of TVT are higher than in colposuspension, but postoperative complication rates (such as infection) are lower. TVT complication rates in more recent studies are lower than in the older studies, perhaps owing to the greater experience of surgeons. Long-term complication rates have not been evaluated adequately. Overall patient satisfaction levels after surgery are about the same as for other procedures. The effectiveness of TVT for other types of urinary incontinence has not been evaluated fully. Ontario utilization: Between 13,500 and 45,807 women with SUI may be eligible for TVT. Up to 43 hospitals in Ontario perform TVT. Hospital TVT volumes are un known. The precise use of TVT in Ontario is unknown. Manufacturers' sales figures provide a proxy for use. The characteristics of patients receiving TVT are unknown. The specialty/training of physicians and the number of patients per provider performing TVT are unknown. Ontario health system: Hospitals pay for TVT from their global budget and therefore control the dissemination of TVT. There is no way to distinguish hospital costs of TVT from other traditional sling procedures using administrative data. There is no distinct professional code for TVT, therefore there is no way to distinguish professional costs of TVT from other sling procedures. Complications arising from TVT are associated with a lack of surgical training. Because there are no distinguishing codes in the health administrative databases for TVT, the only way to examine the use of TVT in the province is through its manufacturers' sales figures. Diffusion: It appears that TVT is replacing some of the more invasive surgeries for TVT in Ontario and the United Kingdom. If TVT is more widely accessible, women may opt for TVT where more invasive procedures were contraindicated.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.health.gov.on.ca/english/providers/program/mas/tech/techlist_ mn.html

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Medical Advisory Secretariat

Contact Address: Medical Advisory Secretariat, 20 Dundas Street West, 10th Floor, Toronto, ON M5G 2N6 CANADA. Tel: 416-314-1092l; Fax: 416-325-2364;

Contact Name: MASinfo.moh@ontario.ca

Contact Email: MASinfo.moh@ontario.ca

Copyright: Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care