Five-Year Outcomes of the IRIS Procedure for the Treatment of Female Stress Urinary Incontinence: Comparison with the TVT Procedure

Phil Hyun Song; Chang Ho Hyun; Hwa Su Lim; Hee Chang Jung

doi:10.4111/kju.2009.50.8.767

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Song, Hyun, Lim, and Jung: Five-Year Outcomes of the IRIS Procedure for the Treatment of Female Stress Urinary Incontinence: Comparison with the TVT Procedure

Original Article

Korean J Urol 2009;50(8):767-773.

Published online: 17 August 2009

DOI: https://doi.org/10.4111/kju.2009.50.8.767

Five-Year Outcomes of the IRIS Procedure for the Treatment of Female Stress Urinary Incontinence: Comparison with the TVT Procedure

Phil Hyun Song, Chang Ho Hyun, Hwa Su Lim, Hee Chang Jung

Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea

Correspondence to: Hee Chang Jung Department of Urology, College of Medicine, Yeungnam University, 317-1, Daemyung-dong, Nam-gu, Daegu 705-035, Korea TEL: 053-620-3692 FAX: 053-627-5535 E-mail: junghc@ynu.ac.kr

Received 22 May 2009 Accepted 16 July 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the longterm efficacy and safety of the innovative replacement of incontinence surgery (IRIS) procedure and compared these with the tension-free vaginal tape (TVT) procedure for the treatment of female stress urinary incontinence.

Materials and Methods

We included 111 consecutively treated women who underwent IRIS (n=51) or TVT (n=60) between January 2002 and December 2003 and followed them up for at least 5 years postoperatively. We analyzed the 5-year success rate and postoperative complications of the IRIS procedure and compared these with the results of the TVT procedure.

Results

The 5-year success rate was 92.2% for the IRIS procedure and 93.3% for the TVT procedure, and the satisfaction rates were 90.2% and 85.0%, respectively. Intraoperative complications for the IRIS group included 4 cases of bladder perforation, and there were 5 cases of bladder perforation in the TVT group. The postoperative complications for the IRIS group included 3 patients with de novo urgency, 2 patients with mesh exposure, and 1 patient with temporary urinary retention. Four patients in the TVT group developed de novo urgency, 2 patients had mesh exposure, and 2 patients showed temporary urinary retention.

Conclusions

Our results suggest that IRIS may be an effective and safe procedure compared with the TVT procedure for more than 5 years.

Keywords: Stress urinary incontinence, Urologic surgical procedures

REFERENCES

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Table 1.

Characteristics of the 111 patients

	IRIS	TVT	p-value
No. of patients	51	60
Mean age, years (range)	51.5±10.8 (30-78)	51.4±9.9 (31-74)	0.941
Mean parity (range)	2.5±1.4 (1-9)	2.7±1.0 (0-6)	0.459
Mean body mass index, kg/m² (range)	24.3±3.2 (17.8-33.7)	24.0±2.2 (18.8-29.7)	0.684
Mean duration of symptoms, years (range)	5.7±4.9 (1-20)	7.0±6.6 (0.2-30)	0.250
Mean followup periods, months (range)	73.8±6.3 (60-82)	75.6±6.4 (60-83)	0.121
No. with previous pelvic surgery (%)	11 (21.6)	14 (23.3)	0.826
Previous anti-incontinence surgery	2 (3.9)	2 (3.3)	0.871
Hysterectomy	6 (11.8)	7 (11.7)	0.987
Other pelvic surgery	3 (5.9)	5 (8.3)	0.618
No. with urge incontinence (%)	15 (29.4)	11 (18.3)	0.179
No. with SUI grade (%)			0.906
I	26 (51.0)	30 (50.0)	0.919
II	24 (47.0)	28 (46.7)	0.967
III	1 (2.0)	2 (3.3)	0.654
Mean 1 hour-pad test, gram (range)	16.7±9.9 (4-46)	18.4±8.9 (7-53)	0.351
Mean urodynamic parameters
No. of patients	13	16
MCC, ml (range)	394.2±121.3 (198-617)	414.1±112.0 (231-607)	0.663
Maximum detrusor pressure, cmH₂O (range)	33.2±20.6 (9-80)	35.3±17.3 (12-70)	0.774
VLPP, cmH₂O (range)	76.2±25.7 (37-124)	75.9±18.0 (45-107)	0.973
MUCP, cmH₂O (range)	50.8±33.3 (9-111)	58.8±23.8 (11-104)	0.472

IRIS: innovative replacement of incontinence surgery, TVT: tension-free vaginal tape, SUI: stress urinary incontinence, MCC: maximum cystometric capacity, VLPP: Valsalva leak point pressure, MUCP: maximal urethral closure pressure, Values are given as Mean±standard deviation (SD), Data were evaluated using Student's t-test and chi-square test

Table 2.

Perioperative results of the IRIS and TVT procedures

	IRIS	TVT	p-value
Mean operation time, minutes (range)	25.1±4.3 (18-35)	26.1±5.0 (15-40)	0.236
No. anesthesia (%)			0.821
Local	4 (7.8)	3 (5.0)	0.866
Spinal	44 (86.3)	53 (88.3)	0.550
General	3 (5.9)	4 (6.7)	0.749
Mean hospital stay, days (range)	3.0±0.8 (2-5)	3.0±0.6 (2-5)	0.860
Mean duration of indwelling cathter, days (range)	1.1±0.5 (0-3)	1.1±0.5 (0-3)	0.927

IRIS: innovative replacement of incontinence surgery, TVT: tension-free vaginal tape, Values are given as Mean±standard deviation (SD), Data were evaluated using Student's t-test and chi-square test

Table 3.

Success and satisfaction rates of the IRIS and TVT procedures according to followup periods

	1 year			3 year			5 year
	IRIS	TVT	p-value	IRIS	TVT	p-value	IRIS	TVT	p-value
Success rate (%)
Cured	43 (84.3)	53 (88.4)	0.546	42 (82.3)	51 (85.0)	0.711	41 (80.4)	49 (81.6)	0.866
Improvement	7 (13.7)	5 (8.3)	0.375	6 (11.8)	7 (11.7)	0.987	6 (11.8)	7 (11.7)	0.987
Failure	1 (2.0)	2 (3.3)	0.654	3 (5.9)	2 (3.3)	0.532	4 (7.8)	4 (6.7)	0.815
Satisfaction rate (%)
Very satisfied	44 (86.3)	48 (80.0)	0.381	41 (80.4)	47 (78.4)	0.791	38 (74.5)	43 (71.7)	0.739
Satisfied	2 (3.9)	4 (6.7)	0.520	4 (7.8)	6 (10.0)	0.693	8 (15.7)	8 (13.3)	0.730
So-so	4 (7.8)	7 (11.7)	0.500	3 (5.9)	5 (8.3)	0.866	2 (3.9)	5 (8.3)	0.332
Dissatisfied	1 (2.0)	1 (1.6)	0.909	3 (5.9)	2 (3.3)	0.532	3 (5.9)	4 (6.7)	0.866

IRIS: innovative replacement of incontinence surgery, TVT: tension-free vaginal tape, Data were evaluated using chi-square test

Table 4.

Preoperative and postoperative uroflowmetry results

IRIS	Preoperative	Postoperative
IRIS	Preoperative	At 1 year	At 3 years	At 5 years
Voided volume	267.0±103.5	282.2±92.0	298.2±62.3	290.2±77.1
Qmax	27.6±10.6	24.6±7.6	26.1±6.1	26.4±7.9
PVR	9.7±7.2	12.7±11.4^a	15.4±15.0^a	18.2±13.1^a

TVT	Preoperative	Postoperative
TVT	Preoperative	At 1 year	At 3 years	At 5 years
Voided volume	285.6±108.9	296.1±97.6	301.8±69.5	305.3±82.4
Qmax	29.8±9.0	26.6±7.6	27.2±7.5	28.5±9.1
PVR	9.0±6.8	11.9±10.8^a	14.9±14.2^a	17.3±11.7^a

IRIS: innovative replacement of incontinence surgery, Qmax: maximal flow rate, PVR: post void residual urine volume, Values are given as Mean±standard deviation (SD)

^a p<0.05 compared to preoperative value

Table 5.

Intraoperative and postoperative complications

	IRIS	TVT
Intraoperative complications (%)
Bladder perforation	4 (7.8)	5 (8.3)
Massive hemorrage	0 (0.0)	0 (0.0)
Postoperative complications (%)
De novo urgency	3 (5.9)	4 (6.8)
Acute urinary retention	1 (1.9)	2 (3.3)
Vaginal erosion	3 (5.9)	2 (3.3)
Mesh exposure	2 (3.9)	2 (3.3)
Inguinal pain	0 (0.0)	0 (0.0)

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