Abstract
The published literature has focused mainly on the efficacy of tension-free vaginal tape (TVT) in correcting stress incontinence with few reports of complications. We report our experience with the first 52 cases of TVT, specifically assessing voiding dysfunction after the procedure. We carried out a retrospective study of patients undergoing TVT surgery for stress urinary incontinence (SUI) between April 2001 and July 2003. Data were collected on period of catheterization, voiding and storage symptoms, their duration and management. Fifty-two women with a mean age 54 years (36–77) were included. Postoperatively, the urethral catheter was removed routinely within 12 h. Twelve patients (23%) failed to void spontaneously and needed recatheterization. Ten of them (83%) were able to resume spontaneous voiding within 3 months. Twenty patients (38%) complained of storage symptoms postoperatively. Sixteen (80%) responded to conservative treatment. Transient urinary symptoms after TVT sling for SUI are common but can usually be managed conservatively.
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Editorial Comment: This is an interesting article regarding the initial experience with TVT from a single author. Their success rate in curing stress incontinence is similar to that noted in previous larger studies; however, their complication rate with postoperative voiding dysfunction appears to be higher than most reported series. This may be due to the strict nature of their reporting, including four patients who were able to void spontaneously within 4 days. It may also be a factor of their initial inexperience with the procedure and possibly placing the sling too tight. The authors did note deviation from the technique as originally described by Ulmsten in that it was done under general anesthesia or spinal anesthesia. However, it does appear that they left the sling very loose, from the description of their technique. It is also interesting in that in those recalcitrant cases, urethral dilation was successful in two of three. Therefore, this article suggests that urethral dilation should be attempted prior to takedown of the sling in subjects with voiding difficulties to determine if this will provide the patients relief. It would be interesting to see if urethral dilation done in the office under local anesthesia would have been as effective
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Mishra, V.C., Mishra, N., Karim, O.M.A. et al. Voiding dysfunction after tension-free vaginal tape: a conservative approach is often successful. Int Urogynecol J 16, 210–214 (2005). https://doi.org/10.1007/s00192-004-1221-1
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DOI: https://doi.org/10.1007/s00192-004-1221-1