Analysis of complications of the tension-free vaginal tape procedure for surgical treatment of female stress urinary incontinence

OBJECTIVE: The most common types of urinary incontinence in women are stress, urge and mixed incontinence. Stress urinary incontinence may be caused by an urethral hypermobility and internal sphincter deficiency (ISD). There are over 100 different surgical procedure for the treatment of female stress incontinence. Tension-free vaginal tape (TVT) is a new anti-incontinence surgical technique which was first described by Ulmsten in 1996. The aim of the study was to evaluate the complications of tension-free vaginal tape (TVT) for the surgical treatment of female stress incontinence. METHODS: The study group was consisted of 162 women, aged 32-84. All patients had a basic evaluation that included a history, frequency/volume chart, questionnaire of micturition (self-made), physical examination, stress test, Bonney test, urinalysis and bacterial culture of urine. Women with mixed urinary incontinence and who underwent surgical treatment of SUI in the past had been done urodynamic investigation. The operation was carried out under epidural, subarachnoid and general anesthesia. The TVT procedure was performed as described by Ulmsten. The follow-up was done after 1 day, 1 and 3 and 6 months since the operation. RESULTS: Among complications related to the procedure were 11 cases of cystotomy, 5 cases of urinary retention requiring four days catheterization, 3 cases of bleeding from the vagina, 14 cases of detrusor instability de novo. In 4 cases occurred postoperative obstinate pain. In 4 cases occurred recurrent urinary tract infection. None complication required invasive treatment. No evidence of defect healing or rejection of the tape was found. CONCLUSIONS: We conclude that the TVT procedure is safe method of the surgical treatment of urinary stress incontinence associated with a low complications.     

Tension-free vaginal tape procedure for treatment of USI: subjective and objective efficacy evaluation

Urinary incontinence is a frequent functional disease affecting 5% to 25% of women. It is commonly believed that urinary stress incontinence (USI) is caused by anatomical defects, thus it can be treated by restoring anatomy. More than 100 surgical techniques have been proposed for genuine stress incontinence treatment. The tension free vaginal tape procedure (TVT) for the treatment of genuine IUS in women was first reported in 1996 by Ulmsten et al. The purpose of this study was to evaluate objective and subjective efficacy of the TVT procedure in different types of female urinary incontinence. From February 2000 to December 2001, 52 patients with urinary incontinence underwent the TVT procedure in the Obstetric and Gynecology Department of Avezzano Hospital, Italy. No difference in the cure rates was found between patients undergoing the TVT alone or associated with anterior and/or posterior colporrhaphy. In accordance with many authors we can affirm that the TVT sling technique is easy to use, the time for surgery is relatively short, and the procedure is free of complications and provides a satisfactory outcome.     

Data from our recent trials with tension-free vaginal tape (TVT) procedure for surgical treatment of genuine urinary stress incontinence

There exist many surgical procedure for the treatment of urinary incontinence. Most of them require relatively extensive surgery and several days hospitalization. The advantage of tension-free vaginal tape procedure is a possibility to be performed on an ambulatory basis and under local anesthesia. OBJECTIVES: The aim of the study was to evaluate the results and morbidity of TVT procedure in genuine urinary stress incontinence. MATERIAL AND METHODS: The study group consists of 26 women, aged 39-69, suffering from genuine stress incontinence class I to III according to Stamey classification. The operation was carried out under epidural anesthesia. The procedure was performed as described by Ulmsten at al. The period of follow-up ranged from 3 to 20 month. RESULTS: The mean time of procedure was 26 minutes (range 18-43). The stay in hospital in 23 patient (88.46%) did not exceed 2 days. Three patients experienced urinary retention lasting four days requiring catheterization. No patients had bladder perforations or severe blood loss. No evidence of defect healing or rejection of the tape was found. Twenty four patients (92.31%) of patients were completely cured, 2 patients (7.69%) had considerably improved urinary continence. CONCLUSIONS: Our early study indicate that TVT procedure is effective and safe method of the surgical treatment of urinary stress incontinence in women.     

Results of tension-free vaginal tape in patients with or without vaginal hysterectomy

OBJECTIVE: To assess complications and cure rates of tension-free vaginal tape (TVT) procedure performed with or without vaginal hysterectomy. STUDY DESIGN: Retrospective comparison of 41 women with urinary incontinence treated by a TVT procedure alone and 40 combined with vaginal hysterectomy. Objective cure was evaluated by clinical and urodynamic examination and by the contilife questionnaire. All patients were operated under regional anesthesia. RESULTS: The two groups were similar in age, parity, menopausal status and type and severity of incontinence. There was no difference in overall complication rates. In the TVT-hysterectomy group, there was a trend towards more bladder perforation (P=0.09). Post-operative urinary flow was lower in the TVT-hysterectomy group: 14 versus 24 ml/pc (P=0.02). The mean follow-up was similar: 23 and 25 months, respectively. No difference in objective and subjective cure rates was found between TVT group and TVT-hysterectomy group: 97.6% versus 92.5% and 68.3% versus 75%, respectively. CONCLUSION: TVT is a safe and effective surgical treatment of urinary incontinence. The association of the procedure with vaginal hysterectomy gave similar short-term objective and subjective cure rates than TVT technique alone.     

Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence

OBJECTIVES: Prospective evaluation of outcome and complications over a 5-year period post-treatment of urinary stress incontinence by TVT, and comparison of our results with the reference studies. MATERIALS AND METHODS: About 94 patients were treated for urinary stress incontinence only by one TVT procedure (single surgical procedure), between April 1997 and December 1998; 68% of patients presented pure urinary stress incontinence and 32% mixed incontinence. We found also a 25.5% rate of sphincter deficiency (UCP < 20 cm H(2)O) in this cohort. Patients were evaluated after 5 years: 52 complete evaluations (clinical, flow measurement with measurement of post-mictional residue, 24h PAD-test, quality of life questionnaire), 30 complete telephone interviews, 12 lost to follow-up (2 patients deceased). RESULTS: About 87% of the patients had a 5-year follow-up. The success rate was 79.2% overall (84.5% for the pure urinary stress incontinence and 67% for the mixed incontinence cases), and 72.2% for the cases of associated sphincter deficiency. We had only a 13% rate of patients lost to follow-up. More than half of the urinary urgency cases were treated successfully, however with a less satisfactory outcome in cases of bladder instability. The urodynamic exploration appeared to reveal that TVT caused dysuria: 52% of patients had a maximum flowrate below 15 ml/s, but the quality of life was improved, with a 95% rate of satisfaction without functional problems. We observed no late complications such as vaginal erosion or rejection of the prolene; the de novo syndrome was rare, with 8.5% of urinary frequency, 6% of urinary urgency and only 5.7% of invalidating dysuria. We saw no cases of pelvic floor disease after TVT treatment. DISCUSSION: Our casuistry results are comparable with the reference studies by Scandinavian authors, Rezapour and Ulmsten, confirming the long-term success of the TVT procedure. Concerning the apparently elevated rates of post-TVT dysuria found by urodynamic exploration, a distinction has to be drawn between post-TVT urinary problems (frequent but oligosymptomatic), and true, severe dysuria (rare). However, "dysuria" in the broad sense did not affect the patients' quality of life, and is a reminder of the absolute necessity of meticulous compliance with the correct surgical techniques. CONCLUSION: Treatment of urinary incontinence by TVT is a reliable, mini-invasive, reproducible technique, almost suitable for outpatients, with no serious complications; it is inexpensive and very successful, including in complicated cases such as sphincter deficiency. All the recent data confirms, with this 5-year follow-up, that the TVT procedure is comparable to the previously gold standard, the Burch colposuspension.     

TVT and TVT-Obturator: comparison of two operative procedures

AIM: To compare two anti-incontinence operations: the tension-free vaginal tape (TVT) and the TVT-Obturator for the first two 75-patient groups. METHODS: One surgeon operated on two patient groups with urodynamically proven urinary stress incontinence. The first 75-patient group in 1998 included the first TVT procedures performed according to Ulmsten [Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J 1996;7:81-6]. Follow-up lasted for 5-6 years. The second 75-patient group in 2004 included the first TVT-Obturator operations performed according to [De Leval J. Novel surgical technique for the treatment of female stress urinary incontinence: transobturator vaginal tape inside-out. Eur. Urol. 2003;44:724-30]. Follow-up lasted for 6-13 months. RESULTS: The two patient groups were similar from the demographic and therapeutic points of view. The TVT-Obturator procedure required neither bladder catheterization nor intra-operative diagnostic cystoscopy. TVT-related bladder penetration (8.0%), post-operative voiding difficulties (5.0%), intra-operative bleeding (4.0%), post-operative field infection (2.7%), and post-operative pelvic floor relaxation (1.3%) were not noted with the TVT-Obturator. The early therapeutic failure rates were 2.7% for the TVT and 1.3% for the TVT-Obturator, and neither bowel nor urethral injuries were recorded. CONCLUSIONS: The surgeons' learning curves of these two minimally invasive surgical procedures for the treatment of female urinary stress incontinence are comparable. The safety and cost-effectiveness of the TVT are well-established. The TVT-Obturator, a novel mid-urethral sling, was designed to overcome some of the TVT-related operative complications. The TVT-Obturator patients seem to have less intra-operative and post-operative surgical complications than the TVT patients. However, long-term comparative data collection is required prior to drawing solid conclusions concerning the superiority of one of these two operative techniques.     

不同路径阴道无张力尿道中段悬吊术治疗重度压力性尿失禁

目的 探讨经耻骨后路径阴道无张力尿道中段悬吊(TVT)术及经闭孔路径阴道无张力尿道中段悬吊(TVT-O)术治疗女性重度压力性尿失禁的临床效果.方法 前瞻性随机对照单盲方法选取重度压力性尿失禁患者69例(其中35例行TVT,34例行TVT-O),部分患者合并Ⅰ～Ⅱ度子宫脱垂及阴道前壁膨出.分别记录两种路径手术的手术时间、术中出血量、术后住院时间、住院费用,以及术中、术后并发症的类型和发生率.运用尿道疾病程度分类问卷(UDI-6)和尿失禁相关生活质量问卷(ⅡQ-7)对两组患者组内及组间手术前后生活质量的变化进行评估.结果 TVT-O组平均手术时间为(18±5)min,明显短于TVT组的(27±5)min,差异有统计学意义(P＜0.01).两组术中出血量、术后第1天B超测量残余尿量的合格率、并发症发生率、术后住院时间和住院费用均相似,差异均无统计学意义(P均＞0.05).术后随访率100%,平均随访时间14.5个月.TVT组治愈率88.6%(31/35),略高于TVT-O组[85.3%(29/34)],但两组间比较,差异无统计学意义(P＞0.05).吊带侵蚀发生率TVT组为5.7%(2/35),高于TVT-O组[2.9%(1/34)];耻骨上、腹股沟或大腿内侧酸痛发生率TVT组为5.7%(2/35),低于TVT-O组[14.7%(5/34)],但差异均无统计学意义(P均＞0.05).两组间手术前后UDI-6和ⅡQ-7问卷各项目评分及总体评分分别比较,差异均无统计学意义(P均＞0.05).两组内手术后UDI-6问卷(除梗阻项目)和ⅡQ-7问卷各项目评分及总体评分较手术前均明显降低,差异均有统计学意义(P均＜0.01),UDI-6问卷中梗阻项目评分,两组内手术前后比较,差异无统计学意义(P＞0.05).结论 TVT-O路径较TVT路径手术时间短,术后短期随访结果显示,两种手术路径均可有效治疗重度压力性尿失禁、改善患者生活质量且不增加尿道梗阻风险,但长期疗效有待进一步随访观察.     

Incomplete bladder emptying after the tension-free vaginal tape procedure,necessitating release of the mesh. A report of three cases

BACKGROUND: The Tension Free Vaginal Tape (TVT) (Ethicon, Inc., Somerville, New Jersey) procedure is a minimally invasive surgical treatment for stress urinary incontinence. Urinary retention is a potential complication that may require release of the tape. CASES: In three cases, prolonged urinary retention occurred after the TVT procedure. Two of the three cases were performed in conjunction with anterior repair. All three patients required surgical release of the tape, which was located at the urethrovesical junction rather than midurethra. All three patients remained stress continent after tape release. One patient developed urge incontinence. CONCLUSION: Excessive tension, as well as tape migration toward the urethrovesical junction, may be the cause of prolonged urinary retention after the TVT procedure. Surgical release of the tape is an effective management approach to this complication.     

The use of prophylactic antibiotics in the tension-free vaginal tape procedure: is it indicated?

The tension-free vaginal tape (TVT) surgical procedure is well established in the treatment of female urinary stress incontinence. The operation is based on a midurethral Prolene tape support. TVT is accepted as an easy-to-learn and safe minimally invasive surgical technique. Postoperative infections have been described following other surgical methods for correcting female urinary stress incontinence. Hence, prophylactic antibiotics are commonly also used in TVT to minimise this surgical complication. The aim of this analysis was to evaluate the occurrence of infection in relation to TVT and the need for prophylactic antibiotics. Out of 524 patients undergoing TVT and followed for up to 68 months, only three suffered surgical field infections within the postoperative period. The three infective processes developed with a background of retropubic haematoma formation. The literature is reviewed, and the justification for prophylactic antibiotics in the TVT operation is discussed.     

Tension-free vaginal tape (TVT) in women with low urethral closure pressure

OBJECTIVE(S): Aim of the study was to assess the effectiveness and the complications associated with the use of tension-free vaginal tape (TVT) in women with stress urinary incontinence and low urethral closure pressure (LUCP). STUDY DESIGN: Thirty-seven patients with stress urinary incontinence and LUCP who were treated with the TVT procedure have been included in the study. Physical examination and urodynamic investigations were carried out to all women preoperatively and at 6, 12 and 26 months (average, range: 22-30 months), postoperatively. The mean age of the patients was 69 years (+/-13), while mean parity was 2.2 (range 0-3). RESULTS: TVT procedure was carried out in all patients with epidural anesthesia. Postoperative evaluation showed 27 patients (73%) to have been completely cured, four (9.25%) to have a considerable improvement, whereas six patients (16.2%) were classified as failures. Only a few complications occurred. CONCLUSION(S): Our study indicates that the TVT procedure is an effective and well-accepted minimal invasive surgery for treatment of urinary stress incontinence in women with LUCP. The cure rate of 73% could be considered satisfactory. Women with LUCP and 'fixed' urethra, are at significantly increased risk of failure of the procedure.     

阴道无张力尿道中段悬吊术治疗女性尿失禁的临床观察

目的　探讨阴道无张力尿道中段悬吊术 (tension freevaginaltape ,TVT)治疗女性尿失禁的临床效果。方法　回顾性分析自 2 0 0 1年 5月至 2 0 0 3年 2月 ,应用TVT手术治疗的 2 3例 (其中18例为压力性尿失禁 ,5例为混合性尿失禁 )女性尿失禁患者的临床资料。结果　 2 3例TVT手术中 ,除 1例因术中可疑有损伤而改为尿道折叠 (Kelly)术外 ,其余TVT手术均成功 ,手术成功率为96 % (2 2 / 2 3)。 2 0例 (91% )术后排尿功能恢复良好 ,2例 (9% )分别因膀胱不稳定 (运动型急迫性尿失禁 )及感染而发生排尿困难 ,经持续导尿、膀胱训练及药物治疗后 ,均恢复正常排尿功能。平均手术时间为 4 9min。术后两年随访所有患者 ,排尿功能均恢复正常。结论　TVT手术简单、微创、恢复快、效果好。     

Concomitant surgery with tension-free vaginal tape

BACKGROUND: To evaluate the efficacy and feasibility of tension-free vaginal tape (TVT) surgery combined with gynecologic surgery using general anesthesia. METHODS: One hundred and six women with genuine stress incontinence (GSI) diagnosed with a traditional urodynamic examination were prospectively enrolled into this study. All of the 106 women underwent TVT surgery for the treatment of GSI, along with a concomitant hysterectomy procedure, under general anesthesia. We estimated the severity of incontinence symptoms on a visual analog scale (VAS), and used a questionnaire for subjective assessment before and after TVT surgery. The objective assessment of urinary incontinence was carried out with a 1-h pad test and traditional urodynamic examination. Of the 106 patients, 50 had uterine prolapse and underwent transvaginal hysterectomy and anteroposterior colporrhaphy (APC), and another 50 had uterine myoma and underwent laparoscopic-assisted vaginal hysterectomy (LAVH). RESULTS: The follow-up mean interval was 18 months (range 12-36 months). The 50 women undergoing LAVH and TVT surgery had a mean hospitalization of 3.5 days. The subjective success rate was 90.5% and the objective success rate was 86.8%. The other group of 50 women undergoing vaginal total hysterectomy (VTH), APC and TVT surgery had a mean hospitalization of 4.8 days. The subjective success rate was 88.6% and the objective success rate was 84.9%. There were six patients lost to follow-up for several reasons. The rates of complications of bladder perforation, postoperative voiding difficulty and postoperative urinary urgency were 2%, 11% and 10%, respectively; neither pelvic hematoma requiring blood transfusion nor conversion to laparotomy occurred. CONCLUSION: The results of this study prove that the TVT procedure, performed under general anesthesia without the need for the intraoperative cough provocation test to treat GSI, and carried out concomitantly with other gynecologic surgeries, is safe and effective.     

Free Communications

Tension-free vaginal tape (TVT) is a well-established surgical procedure for treating female urinary stress incontinence. The operation, described by Ulmsten et al. in 1995, is based on a midurethral Prolene tape support. TVT is accepted as an easy-to-learn and safe minimally invasive surgical technique. Bladder perforation with sling material was described as a complication of former surgical methods for correcting female urinary stress incontinence as well as of TVT. The aim of this analysis was to determine whether the use of a straight inserter for identifying and displacing the bladder prior to inserting TVT needles reduces the occurrence of bladder penetration. Out of 524 patients undergoing TVT and followed for up to 68 months, 68 (13%) had TVT bladder penetrations, all of which were diagnosed and corrected during surgery. All but the last 50 patients had a straight inserter introduced during the procedure. The effect of this surgical step is estimated and discussed.     

A three-year postoperative evaluation of tension-free vaginal tape

The aim of this study was to evaluate the outcome of tension-free vaginal tape (TVT) 3 years after surgery. Fifty-one women (mean age 52.9) with a genuine stress incontinence underwent the TVT operation. In 10 patients, a prolapse repair was also done simultaneously. The majority of the patients were operated under local anesthesia. All patients were evaluated 3 years after the procedure using a protocol for objective and subjective assessment of the outcome including an evaluation of quality of life related to urinary incontinence. According to the protocol, 46 women (90%) were successfully cured, another 3 patients (6%) were improved, whereas 2 patients (4%) were classified as failures. Few complications occurred. We conclude that TVT is a simple and well-accepted minimal invasive surgery for treatment of female urinary stress incontinence. The outcome 3 years after the operation showed no signs of deterioration compared to the results shortly after surgery. The cure rate of 90% is comparable with the best results of other surgical treatments for female urinary incontinence. Copyright Copyright 1999 S. Karger AG, Basel     

女性压力性尿失禁的综合治疗

目的:探讨女性压力性尿失禁(stressurinaryincontinence,SUI)的治疗方法和效果。方法:压力性尿失禁51例采用经阴道无张力尿道中段悬吊带术治疗23例,药物和功能训练治疗28例。结果:手术治疗组23例手术时间平均35min,出血量平均15ml,随访患者3~23月, 21例(91 .3% )治愈, 2例明显改善。4例出现并发症,其中术中膀胱损伤3例,术后尿潴留1例。非手术治疗28例2例治愈, 18例有不同程度地改善, 8例无效,总有效率为71 .4%。结论:经阴道无张力尿道悬吊带术是治疗女性压力性尿失禁十分有效的微创方法,药物治疗和功能训练有一定的改善作用。     

TVT procedure--the critical analysis of clinical effectiveness and complications among first 100 cases

RATIONALE: Since its clinical debut in 1996 TVT procedure has been offering an excellent clinical tool both for patients and surgeons to treat SUI suffering women. Since the learning curve is an important factor influencing the rate of surgical complications as well as the clinical outcome of any new surgical technique we decided to analyse the first 100 cases of SUI women treated with TVT technique. AIM OF THE STUDY: To analyse clinical effectiveness and complications among first 100 consecutive cases of TVT procedures. MATERIAL AND METHODS: One hundred women aged from 30 to 89 years (old mean 55.6) were hospitalised in our Department from September 1999 to November 2000 because of SUI as confirmed by the complete urogynecologic assessment including history and physical examinations, catheterised residual volume determination, and multichannel urodynamic testing. TVT procedure was performed as originally described by Ulmsten et al. except the fact that 43 operations were performed not under local but epidural anesthesia. For 80 patients TVT was offered as the primary surgery for SUI treatment whereas for 14 it was the second and for 6 the third or more attempt. RESULTS: Operation was performed without any technical difficulties in all cases (mean time 25 min). Bladder injury (treated by 1 or 2 days catheterization) occurred in 9 cases, urinary retention in 13 (in 6 cases after 10-14 days tape was cut). Urinary tract infections occurred in 4 women despite intraoperative 2.0 g i.v. piperacillin prophylactics and fosfomycin trometamol 3.0 g p.o. in first postoperative day. Subsequent urge incontinence developed in 4 patients. Clinical efficacy based on medical history, cough test and Gaudenz questionnaire was 95% (observation period 3 to 16 months, mean 8 months). CONCLUSIONS: In our opinion TVT procedure is an operation of choice to treat SUI in women regardless of their age because of its excellent clinical effectiveness accompanied by its technical simplicity, reproducibility and low percentage of serious complications. Previous urogenital surgery is a risk factor for bladder perforation during TVT procedure.     

TVT tape usage in the treatment of stress urinary incontinence

Stress urinary incontinence is one of the most common gynecological complains. The frequency of its occurrence is from 12 to 25 and even 60%. It is most often observed in patients after menopause, but in a few percent is also found in twenty and thirty years old women. During several years of searching the effective methods of stress urinary incontinence treatment, many operative techniques have been worked out, but none of them became a perfect one. The operation with the use of TVT tape is one of the newest methods of the stress urinary incontinence treatment. The aim of our study was the attempt of the estimation the TVT operation effectiveness in the treatment of stress urinary incontinence in women treated in Surgical Gynecology Department of Polish Mother Health Centre Research Institute in years 2000-2002. Performed analysis of 60 patients at the age between 38 and 76 years revealed that stress urinary incontinence symptoms regressed after TVT operation, as evaluated 7 days after the procedure. In 51.7% of patients anterior colpoplasty or colpoperineoplasty was performed simultaneously to TVT operation. Control studies were performed a month and six months after the operation. Recurrence of the symptoms was observed in 11.7% of the patients. Revealed data let us show that the efficacy of this procedure is very high and reaches 88.3%.     

TVT手术在女性压力性尿失禁中的应用

目的 :探讨TVT手术作为治疗女性压力性尿失禁新手术方法的有效性。方法 :回顾性分析自 2 0 0 1年 5月以来 ,我院应用TVT手术治疗女性压力性尿失禁的临床疗效及并发症。结果 :17例尿失禁患者 (其中 13例压力性尿失禁 ,4例混合性尿失禁 )接受TVT手术 ,15例 ( 88 2 % )术后排尿功能恢复良好 ,2例 ( 11 8% )发生排尿困难 ,均经持续导尿、膀胱训练及药物治疗后恢复正常排尿功能。VTV手术的成功率为 10 0 %。结论 :TVT手术具有简单、微创、恢复快等特点 ,是治疗女性压力性尿失禁的安全有效方法     

Short- and long-term results of the tension-free vaginal tape procedure in the treatment of female urinary incontinence

BACKGROUND: The aim was to describe the short- and long-term results of treatment for urinary incontinence (UI) in women using the tension-free vaginal tape (TVT) procedure at a single unit and to identify factors predictive of successful outcome. MATERIAL AND METHODS: Consecutive female patients (n = 707) treated for UI with the TVT procedure at Karlstad Hospital from November 1996 to June 2004 were included. After a standardized preoperative evaluation, the women were classified as having either stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). The results of surgery were evaluated after 1, 2, and 5 years, by means of a postal questionnaire. An objective evaluation was performed after 5 years in a subsample of the first patients included (n = 59). Factors influencing the cure rate were analyzed using multiple regression analysis. RESULTS: The subjective cure rate was 83% after 1 year and 73% after 5 years. The objective cure rate was 83% in the subgroup after 5 years. Surgical time was 30+/-9 min (mean+/-SD). The rate of bladder perforations was 1.7%. In patients with MUI the cure rate was lower than in patients with SUI (after 5 years 54.9% versus 81.0%). Type of incontinence was the only independent variable found to influence surgical outcome. CONCLUSIONS: The TVT procedure, performed in over 700 women at a single gynecological unit, was found to be a safe and efficient surgical procedure. Type of incontinence was the only independent variable found to predict for outcome of surgery.     

Colpocleisis and tension-free vaginal tape sling for severe uterine and vaginal prolapse and stress urinary incontinence under local anesthesia

STUDY OBJECTIVE: To describe the technique, complications, and outcomes of vaginal repair of concomitant advanced uterine and vaginal prolapse and stress urinary incontinence using colpocleisis and tension-free vaginal tape (TVT) and pubovaginal sling under intravenous sedation and local anesthesia in elderly and/or medically compromised patients. DESIGN: Retrospective analysis (Canadian Task Force classification III). SETTING: Large tertiary care hospital with university affiliation. PATIENTS: Thirty consecutive women. INTERVENTION: Colpocleisis and TVT-pubovaginal sling. MEASUREMENTS AND MAIN RESULTS: Data were obtained by retrospective chart review of office and surgical records and follow-up physical examinations. All 30 patients had the procedure completed without general anesthesia. Mean estimated blood loss was 56 ml (range 10-150 ml), mean operating time 97.3 minutes (range 65-135 min), and mean hospital stay 1.62 days (range 1-12 days). No intraoperative complications occurred, although one woman experienced a postoperative myocardial infarction. Average follow-up was 19.1 months. Three women required reoperation for minor prolapse (2 posterior repairs, 1 anteroposterior repair) and 94% were cured of stress incontinence. CONCLUSION: Preliminary data suggest that surgical correction of concomitant severe pelvic organ relaxation and stress urinary incontinence using a proved procedure (pubovaginal sling) coupled with colpocliesis can be performed rapidly and safely with local anesthesia and mild sedation, thus limiting the potential risks of general anesthesia and more invasive surgical procedures.