Abstract
Background/Objectives: The use of tension-free vaginal tape obturator (TVT-O) for the treatment of stress urinary incontinence (SUI) has been widely debated over the last decade due to the lack of evidence on its long-term outcomes. The aim of this prospective study is to assess, for the first time in the available literature, the efficacy and safety of TVT-O implantation in women with pure SUI over a 17-year follow-up period. Methods: We included all women who complained of pure SUI symptoms (confirmed urodynamically) and underwent the TVT-O procedure. An objective cure was defined as the absence of urine leakage during the stress test, while subjective outcomes were assessed by means of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS). Results: A total of 70 patients who met the inclusion criteria underwent the TVT-O procedure. During the study period, no patients were lost to follow-up, and all women completed the last evaluation at the 17-year mark. At the 17-year mark of follow-up, 62 out of 70 patients (81.4%) were subjectively cured, and 56 out of 70 (80%) patients were objectively cured. These data do not reveal any significant variation in the surgical outcomes over the follow-up period. We recorded seven (10%) tape exposure (three occurred after 10 years and four after 17 years). Among these, one woman was symptomatic for dyspareunia and "hispareunia". All patients with mesh exposure were treated with partial removal and re-suture of the vagina, but only one developed the recurrence of SUI that required a second treatment with a urethral bulking agent (UBA). In all other cases, women reported a complete resolution of symptoms without any worsening of the urinary continence. No significant bladder or urethral erosion was recorded. Conclusions: The 17-year evaluation of the TVT-O procedure has shown that it is a highly effective and safe option for the treatment of female SUI. Although there was an increased risk of tape exposure 17 years after implantation, no serious complications were reported, and no patient required the total removal of the sling.