The tension-free vaginal tape procedure

This article discusses the tension-free vaginal tape (TVT) procedure, which attempts to recreate urethral support at the level of the pubourethral ligaments by placing a polypropylene sling at the midurethra as opposed to the bladder neck. The procedure has the proposed advantage of being done under local anesthesia and being an outpatient surgery and can be performed transvaginally or suprapubically.     

Concomitant resection of congenital vaginal septum during the tension-free vaginal tape procedure

This case report illustrates how the tension-free vaginal tape (TVT) procedure can be successfully combined with another gynecological intervention. A 38-year-old patient had been diagnosed with didelphys uterus during cesarean section. She came to us for treatment of confirmed genuine stress incontinence. In conjunction with the TVT procedure, we resected the congenital vaginal septum. The patient has remained continent for over 1 year.     

True occult bladder perforation during placement of tension-free vaginal tape

Bladder perforation is one of the most common complications of the trans-vaginal tape (TVT) procedure, and is generally identified on routine intra-operative cystoscopy. We present a case of occult bladder perforation occurring during the TVT procedure that could not be identified by cystoscopy. A 57-year-old woman underwent TVT placement for treatment of stress urinary incontinence. A bladder perforation, suspected because of clear fluid at one of the abdominal incision sites, could not be identified with cystoscopy, but was confirmed with bladder installation of sterile infant formula. The tape was removed and the bladder was drained for 48 h. The patients recovery was uneventful and she subsequently underwent TVT placement without complication. Cystoscopy alone may be inadequate for identification of some bladder perforations during the TVT procedure. Awareness of alternative methods of identification is essential.     

Spontaneous delivery following tension-free vaginal tape procedure

There has been no report in the international literature concerning vaginal delivery following tension-free vaginal tape (TVT) procedure. Most gynecologists recommend cesarean section after TVT procedure. We present the case of a 37-year-old (gravida 2, para 2) woman who had spontaneous delivery at 40 weeks’ gestation after TVT procedure performed 10 months prior because of stress urinary incontinence. Five months after spontaneous delivery, the patient was shown to be continent, with no urinary leakage occurring following stress maneuver. Urodynamic evaluation showed normal urethral pressure profile and sufficient maximum urethral closure pressure. Introital ultrasound demonstrated the correct position of the Prolene tape. In cases of pregnancy following TVT procedure, a general recommendation of delivery by cesarean section may be questioned, since the function and correct suburethral position of the Prolene tape can also remain intact following vaginal delivery.     

Vaginal delivery after tension-free vaginal tape procedure

To treat genuine stress urinary incontinence, the surgical technique of choice at present is suburethral tension-free vaginal tape (TVT) procedure. Because of its good results and low morbidity, TVT is now offered to younger women still of childbearing age. We describe a patient who delivered vaginally 2 years after undergoing a retropubic TVT procedure. The woman remained continent throughout her pregnancy and at 6 months postpartum, with normal urodynamic parameters.     

Sexual function after tension-free vaginal tape procedure

INTRODUCTION: Aim of this cross-sectional study was to analyze the sexual function of women after tension-free vaginal tape (TVT) procedure. PATIENTS AND METHODS: To evaluate the female sexual function after the TVT procedure, we designed a 36-item questionnaire including 21 questions on incontinence, 15 questions on sexuality and 3 questions on the personal impression of the procedure. Diagnostic workup consisted of a detailed medical history, urinalysis, postvoid residual urine volume assessment, ultrasound of the kidney and a urodynamic study. RESULTS: Fifty-two women completed the entire questionnaire. Overall, 82.7% of the women were satisfied with the TVT procedure. A proportion of 74.0% indicated that they became totally continent after the operation. One third of the sexually active women reported an improvement of their sexual life after TVT, 14.3% a worsening, and 52.4% reported no change. Deterioration of sexual function was significantly associated with de novo urge, dyspareunia and sensation of postvoid residual urine volume. CONCLUSION: In summary, our investigations showed that the influence of the TVT procedure on female sexual function is evident, but of low impact, and in general will not be of relevance.     

Voiding dysfunction after the tension-free vaginal tape procedure

Throughout the past decade, pubovaginal slings have become the most widely used surgical procedure for the treatment of stress urinary incontinence. However, despite its widespread use and success rates, it is associated with a significant complication rate. In response to the high complication rate, the tension-free vaginal tape (TVT) was introduced. Based on the integral theory that stress urinary incontinence results from defective urethral support, the TVT consists of a loosely placed piece of prolene mesh under the urethra to recreate the pubourethral ligament. However, despite its tension-free nature, studies have shown that the TVT causes postoperative voiding dysfunction in 2.8% to 14% of patients. Radiologic and urodynamic studies suggest that postoperative voiding dysfunction is related to a change in outflow resistance during voiding, not to a change in the bladder neck positioning at rest. Although voiding dysfunction appears to be less after TVT than colposuspensions and the early pubovaginal slings, it does exist and patients should be warned of the potential complication.     

Incisional hernia after a tension-free vaginal tape procedure

A case is presented of an incisional hernia of the inguinal canal presenting 9 months after a tension-free vaginal tape (TVT) procedure and anterior vaginal repair. The TVT and repair procedure was complicated by prolonged postoperative urinary retention requiring midline incision of the tape for resumption of normal voiding. The patient had a hysterectomy several years earlier via a Pfannenstiel incision. No other risk factors for hernia were identified. There are no previous reports of TVT-related incisional hernia. We conclude that incisional hernia is a rare complication of the TVT procedure and that the characteristics of the TVT tape may contribute to late occurrence of herniation.     

A case report of transurethral resection of eroding urethral mesh after a tension-free vaginal tape procedure

A 72-year-old woman presented with lower urinary tract symptoms (incomplete voiding, voiding pain, and gross hematuria) 2 years after a tension-free vaginal tape (TVT) procedure for stress urinary incontinence. Cystoscopy revealed erosion of the urethra associated with a urethral stone attached to a polypropylene mesh. We performed transurethral resection of the polypropylene mesh and transurethral lithotripsy. After removal of the mesh, she had stress urinary incontinence but her symptoms resolved. Urethral erosion is a rare complication of TVT, and the method of handling the intrusive mesh has not been standardized. Transurethral endoscopic resection of the eroding mesh is a minimally invasive and successful procedure that should be considered for the treatment of this complication resulting from TVT.     

Surgical intervention for complications of tension-free vaginal tape procedure

PURPOSE: The tension-free vaginal tape procedure has become a state of the art operation for female stress urinary incontinence. Cases of complications requiring surgical revision are reported to be rare. We report on 6 patients with complications necessitating surgery. MATERIALS AND METHODS: Six patients who previously underwent the tension-free vaginal tape procedure required surgical management of complications, including intravesical polypropylene mesh tape with incrustation and chronic urinary tract infection in 2, vaginal mucosal mesh erosion of the vaginal incision in 1 and permanent urinary retention in 3. RESULTS: The intravesical tapes were resected via a suprapubic approach. In the case of disturbed wound healing the periurethral part of the tape was resected transvaginally. A patient in urinary retention underwent resection of the periurethral sling, while in the other 2 the tapes were transected transvaginally. Two patients in whom incontinence recurred were successfully treated with a repeat tension-free vaginal tape procedure during followup. CONCLUSIONS: Complications of the tension-free vaginal tape procedure that require surgical intervention are rare. The surgeon must be aware that this operation may lead to an additional surgical procedure, significantly increasing morbidity.     

Development of vesical calculi following tension-free vaginal tape procedure

We present a case of a bladder stone that had formed around the intravesical portion of tension-free vaginal tape (TVT) material following unnoticed bladder perforation during the procedure. Endoscopic lithotripsy of the bladder calculi was performed and the TVT sling material was removed by an endoscopic approach. High clinical suspicion of bladder complications is necessary when evaluating patients presenting with urinary symptoms after a TVT procedure.     

Clinical and urodynamic outcomes of tension-free vaginal tape procedure

The tension--free vaginal tape procedure (TVT) has been regarded as a safe, minimally invasive method for the treatment of female stress urinary incontinence. In a prospective multicenter study we evaluated safety and efficacy of TVT procedure for the treatment of female stress incontinence. From 1998. to 2003, a total of 42 patients, mean age 60 years (range 34-76) with urodynamically verified stress urinary incontinence underwent the TVT procedure. The mean follow-up period was 28 months (range 14 to 32). Intra- and postoperative complications were few, including bladder perforations (4.7%), vaginal hematoma (2.4%), complete urinary retention (2.4%), transient urinary retention (19%) and urinary tract infection (7.1%). Postoperatively, voiding time and functional urethral length significant increased. The subjective and objective cure rates were 85.7% and 90.5%, respectively. We conclude that the TVT procedure is associated with high cure rate and low morbidity.     

Long-term follow-up of the retropubic tension-free vaginal tape procedure

Introduction and hypothesis

Retropubic tension-free vaginal tape (TVT) was introduced in 1996 as a new and innovative surgical approach in the treatment of stress urinary incontinence (SUI). In this study we evaluate the long-term objective and subjective outcomes in a non-selected patient population 10 years after the retropubic TVT procedure.

Methods

All women (603) operated on with retropubic TVT at four gynecological departments from September 1998 through December 2000 were identified, and those still alive (542) were invited to participate in this population-based prospective study. For subjective data a short-form urinary incontinence disease-specific questionnaire was used. For objective evaluation the women underwent a stress test. Data collected were merged with previously stored data in the Norwegian National Incontinence Registry Database.

Results

We included 483 women; 327 attended a clinical follow-up consultation and 156 had a telephone interview. Median duration of follow-up was 129 months. Objective cure rate was 89.9 %, subjective cure rate was 76.1 %, and 82.6 % of the patients stated they were “very satisfied” with their surgery (treatment satisfaction rate). Only 2.3 % of the women had undergone repeat SUI surgery. Subjective voiding difficulties were reported by 22.8 %, the majority describing slow stream or intermittency. De novo urgency incontinence increased significantly from 4.1 % 6–12 months after surgery to 14.9 % at the 10-year follow-up.

Conclusions

Long-term objective and subjective outcome after retropubic TVT is excellent with a low number of re-operations even in a non-selected cohort of patients.     

Hemorrhagic complication during placement of tension-free vaginal tape

A 66-year-old para III with a 20-year history of stress urinary incontinence underwent placement of tension-free vaginal tape. Intraoperative arterial bleeding occurred. An expanding hematoma was palpated postoperatively. Interventional radiology performed a pelvic arteriogram with selective bilateral internal iliac arteriograms, a supraselective anterior division and obturator arteriogram, a left external iliac arteriogram, coil embolization of a branch of the left obturator artery, and gel foam embolization of the anterior division of the left internal iliac artery.     

Urethral diverticulum after tension-free vaginal tape procedure: case report

This study presents the third case in the literature of a urethral diverticulum after the tension-free vaginal tape (TVT) procedure, with an additional finding of the diverticulum developing distal to the tape. A 54-year-old woman, with 3 years' status post-TVT, presented with urinary tract infection and infravesical obstruction. Urethrocystoscopy revealed a urethral diverticulum just distal to the sling site. Transvaginal diverticulectomy and excision of the sling was done, with improvement of symptoms at 1-year follow-up.     

Stamey与TVT手术治疗女性压力性尿失禁的疗效比较

目的评价Stamey膀胱颈悬吊术和无张力阴道吊带术（TVT）治疗女性压力性尿失禁的疗效.方法总结2种方法治疗49例女性压力性尿失禁的临床资料.Stamey组26例,平均年龄57岁.尿失禁Ⅰ度3例,Ⅱ度15例,Ⅲ度8例.TVT组23例,平均年龄58岁.尿失禁Ⅰ度2例,Ⅱ度13例,Ⅲ度8例.对2组术中记录,术后控尿、合并症以及复发情况进行比较.结果 Stamey和TVT组平均手术时间分别为43 min和27 min.术中膀胱穿孔发生率为19%（5/26）和4%（1/23）.拔尿管后无尿失禁者分别为92%（24/26）和96%（22/23）;尿潴留发生率为8%（2/26）和0%.术后6个月,无尿失禁者分别为89%（23/26）和100%（23/23）.合并耻骨上区疼痛者分别为58%（15/26）和9%（2/23）;排尿不畅或剩余尿＞50 ml者分别为15%（4/26）和9%（2/23）;尿频尿急发生率分别为54%（14/26）和17%（4/23）.结论 2种方法治疗女性压力性尿失禁初期疗效均较好,但TVT法术后指标优于Stamey法.