Objectives
To evaluate the safety and clinical efficacy of the transobturator vaginal tape ‘inside-out’ (TVT-O)
procedure for managing new-onset stress urinary incontinence (SUI) after radical cystectomy (RC) and
orthotopic W-neobladder construction in women.
Patients and methods
Between January 2004 and June 2010, 57 women were treated with RC and orthotopic ileal neobladder
reconstruction. Six of these patients (median age 44 years, range 39–62; grade 2 muscle-invasive
squamous cell carcinoma in four and transitional cell carcinoma in two) developed de novo SUI that
was moderate in four and severe in two. The median (range) duration of SUI was 11 (9–18) months.
All six patients underwent TVT-O for control of their SUI.
Results
Four patients were completely dry day and night (three of them can initiate voiding and one cannot,
and uses intermittent catheterization). One patient improved, as assessed by using fewer pads (from 5–
7 pads to 1 pad/day and night). She can initiate voiding but has minimal leakage only on moderate
exertion. One patient who had severe SUI showed no improvement. Patients were followed for a mean
(range) of 18 (17–32) months, with no deterioration in the continence status.
Conclusion
These encouraging results confirm the safety and clinical efficacy of TVT-O for managing new-onset
SUI after RC and ileal neobladder construction, although a larger survey and a longer follow-up are
needed.
Abbreviations: PVR, post-void residual urine volume; SUI, stress urinary incontinence; TVT(-O),
tension-free vaginal tape (inside-out); RC, radical cystectomy; CIC, clean intermittent selfcatheterisation