A multicentre review of the tension-free vaginal tape procedure in clinical practice

Abstract

A multicentre study was conducted to determine the success of the TVT in a clinical practice and to try to identify factors which may be associated with operative failure or postoperative complications. Three hundred and twenty women were included; the overall subjective success rate was 92.2%; 245 patients had reliable documentation regarding postoperative voiding, 25 had voiding problems (10.2%). Operative success did not appear to be diminished by previous surgery. Increased patient weight had a positive effect on outcome. Irritative symptoms preoperatively had an odds ratio of 1.8 for postoperative voiding difficulties. This study shows that the TVT appears to be an effective operation for genuine stress incontinence with low intra and postoperative complication rates. These results also show that it is highly successful in patients who may not be ideal candidates for other continence procedures either because of previous pelvic surgery or body weight.

Factors predictive of post-TVT voiding dysfunction

“…The predictive variables were abnormal uroflowmetry pattern, peak flow rate <15 ml/s, pre-operative enterocoele or vault prolapse, combined vault suspension with TVT and post-operative urinary tract infection. Pre-operative irritative symptoms have been found to be predictive [4] in one study.…”

“…Voiding dysfunction has been associated with patient characteristics such as increased age [3], irritative bladder symptoms [4], pre-existing enterocoele and vault prolapse [5] as well as previous incontinence or prolapse surgery [3,6,7]. Associations between post-operative voiding dysfunction and the urodynamic variables of reduced peak voiding flow rate and an abnormal uroflowmetry pattern have been made [5,8].…”

An unusual complication of tension-free vaginal tape procedure: recurrent anterior vaginal wall abscess and sinus formation

“…The TVT procedure has gained popularity worldwide, due to its good functional results. A British multicentre randomised trial has reported a subjective cure rate of 92% (Moss et al, 2002). In more than 5 years of experience with the TVT procedure, using prolene as the tape material, no rejection was reported (Nilsson and Kuuva, 2001).…”

Complications of anterior compartment vaginal surgery

“…Historically, the incidence of postoperative voiding difficulties lasting longer than 4 weeks occurs in 3% to 7% of patients undergoing Burch procedures, 4% to 8% of those undergoing transvaginal needle suspensions and 3% to 11% of slings [18]. The incidence of voiding dysfunction, including urinary retention and de novo urgency and urge incontinence, following midurethral slings ranges from approximately 2% to 25% [3,[14][15][16][19][20][21][22][23][24][25][26][27]. Surgical intervention for voiding dysfunction and urinary retention has been reported in 0% to 5% of patients undergoing midurethral slings [15,16,19,20,25,26].…”