Culture-detected urinary bacteria 10–20 years after tension-free vaginal tape surgery and associations with incontinence, pelvic pain, and dissatisfaction: a cross-sectional study

Abstract Background Some women have persistent incontinence or pain after tension-free vaginal tape (TVT) surgery. Our objective was to study any association between culture-detected bacteriuria and incontinence, complications and satisfaction 10–20 years after TVT. Methods Cross-sectional study in 2022 of 127 women operated with TVT between 2001-2012 at Trondheim University Hospital, Norway. Validated questionnaires assessed stress urinary incontinence (SUI), urgency urinary incontinence (UUI), pelvic pain and satisfaction. Urine collected by sterile catheterization was cultivated for two (chromogenic and blood agar) and five days (blood, fastidious and chocolate agar). Symptoms and demographics were compared between women with and without significant bacterial growth, defined as ≥ 1.000 CFU/ml for this study, using chi-square test, Fishers exact test, t-test and logistic regression. Number of species detected after five days culture was tested in association to demographics and symptoms using Mann Whitney-U-test. Results 50/111 women (45.0%) had SUI, 54/122 (44.3%) had UUI, 95/116 (81.9%) were satisfied and 7/123 (5.7%) stated persistent pain. 16 (12.4%) had significant bacterial growth after two days of whom seven (44%) had a positive dipstick screening test (leukocytes or nitrite). After five days culture, 28 (22%) had significant bacterial growth. We found non-significantly higher odds for SUI (aOR 4.2, 95% CI 0.5–36.1) and UUI (aOR 2.1, 95% CI 0.3–13.7) in women with bacterial growth after two days. Bacterial growth after five days was associated with non-significantly increased risk of SUI (aOR 2.3, 95% CI 0.6–8.9) and UUI (aOR 3.4, 95% CI 0.9–13.6). Age was significantly associated with bacterial growth after two (aOR 1.2, 95% CI 1.02–1.3) and five days (aOR 1.1, 95% CI 1.04–1.2). The number of bacterial species after five days culture was higher in women with UUI, BMI > 75 percentile, in those dissatisfied or with persistent pain, than in women without these conditions ( p < 0.01). Conclusions Significant bacteriuria and larger variety of bacterial species were associated with incontinence, pain and dissatisfaction 10–20 years after TVT. The dipstick screening test had a sensitivity of only 44%. Extended urinary culture may be of value in optimizing treatment of urinary tract symptoms after TVT. Trial registration ClinicalTrials.gov (NCT04912830).