Complications and Untoward Effects of the Tension-Free Vaginal Tape Procedure

Karram, Mickey M.; Segal, Jeffrey L.; Vassallo, Brett J.; Kleeman, Steven D.

doi:10.1097/00006250-200305000-00018

Cited by 63 publications

(97 citation statements)

References 9 publications

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“…Ulmsten and Petros ¢rst introduced the TVT Neurourology and Urodynamics DOI 10.1002/nau Kuuva and Nilsson [2002] 1,455 patientsTVT 24/367 6 transfusion/signif bleed (0.4%), 11 bladder perforations (0.75%), 2 vascular injury (0.1%)1 nerve injury (0.07%), 4 abscesses (0.2%) Hong et al [2003] 375 patients, TVT 5/143 1 nerve injury (0.3%), 4 hematoma (1.1%) Kobashi and Govier [2003] 140 patients, SPARC 6/6 4 transfusions (2.8%), 1 bowel perforation (0.7%), 1 hematoma (0.7%) Karram et al [2003] 350 patients, TVT 6/97 2 hematoma (0.9%), 3 nerve injury (0.9%), 1urethral erosion (0.3%) Abouassaly et al [2004] 241 patients, TVT 7/173 6 signi¢cance bleed >500 ml (2.5%), 1 hematoma (0.4%) Levin et al [2004] 313 patients, TVT 2/67 2 unrecognized blad perf (0.6%) Wang [2004] 600 patients, TVT 0/28 Tsivian et al [2004] 200 patients, TVT 1/25 1 unrecognized blad perf (0.5%) Hodro¡ et al [2005] 445 patients, SPARC 2/82 1 bowel perforation (0.2%), 1 rectus hematoma (0.2%) Hammad et al [2005] 1,459 patients, TVT 993, SPARC 466 2/121 2 urethral erosion (0.1%) Paick et al [2005] 274 patients, TVT 0/110 De Leval [2003] 107 patients, TO generic (inside-out) 0/7 Delorme et al [2004] 32 patients, Uratape 0/8 DeTayrac et al [2004] 30 patients, Uratape 1/8 1 obturator hematoma (3%) Costa et al [2004] 183 patients, Uratape 2/20 2 urethral erosion (1%) Mellier et al [2004] 94 patients, Monarc 0/3 Domingo et al [2005] 65 patients, Uratape 43, Obtape 21 1/10 1 obturator abscess (1.5%) Fischer et al [2005] 220 patients, Monarc, Serasis-TO 0/18 Spinosa and Dubuis [2005] 117 patients, ObTape 0/10 Naidu et al [2005] 96 patients, Monarc 0/12 Siegel [2005] 30 patients, ObTape 1/6 1 obturator abscess (3%) Palma et al [2005] 100 patients, SAFYRE 0/20 Krauth et al [2005] 604 patients, I-STOP 1/60 1 signi¢cant bleed (0.2%) Davila et al [2005] 200 patients, Monarc 0/13 Roumeguere et al [2005] 120 patients, Uratape 60, Obtape 60 2/38 2 unrecognized urethra inj (1.7%)…”

Section: Discussionmentioning

confidence: 99%

Presentation and management of major complications of midurethral slings: Are complications under‐reported?

Deng

Rutman

Raz

et al. 2006

Neurourology and Urodynamics

222

130

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Aims: Midurethral slings have become the mainstay of stress urinary incontinence (SUI) treatment due to their e⁄cacy and low complication rates. The purpose of this study was to report the presentation and treatment of major complications from these minimally invasive treatments presented to a tertiary referral practice and to highlight a discrepancy in major complications between literature and the food and drug administration (FDA) device failure database. Methods: From 2001 through 2005, we reviewed all cases of midurethral sling complications that presented to our institution. A literature review of all complications due to midurethral slings during the same time period was performed as was the FDA manufacturer and user facility device experience (MAUDE) database queried for self-reported complications. Results: A total of 26 patients referred to UCLA with voiding dysfunction after sling placement was found to have mesh in the urethra or bladder. Treatments required a combination of urethrolysis with mesh removal, urethral reconstruction with graft, and bladder excision. These were compared to major complications reported in the world literature of <1%. The MAUDE database contained 161 major complications out of a total of 928 complications reported for suburethral slings. There was signi¢cantly more major complications reported in MAUDE than in published literature. Conclusions: Although rare, major complications of midurethral slings are more common than appear in literature. Devastating complications involving urethral and bladder perforations can present with mild urinary symptoms and thus are likely under-diagnosed and under-reported. Most of these cases need to be managed with additional reconstructive surgery. Neurourol. Urodynam. 26:46^52, 2007. ß 2006

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Section: Discussionmentioning

confidence: 99%

Presentation and management of major complications of midurethral slings: Are complications under‐reported?

Deng

Rutman

Raz

et al. 2006

Neurourology and Urodynamics

222

130

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“…Calculations based on these numbers indicate that we have a dyspareunia rate of 1.7% requiring sling removal; however, as this question was not investigated in this study, this is an estimation only. Karram [7] reports 0.9% poor healing at the site of the vaginal incision in his study of 350 patients undergoing sling insertion, and 4.9% voiding dysfunction and 0.5% of patients requiring another incontinence procedure for recurrent or persisting incontinence.…”

Section: Discussionmentioning

confidence: 99%

Sexual function after suburethral sling removal for dyspareunia

et al. 2008

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Introduction Impact on sexual function has received little attention in the medical literature for a long time. Because of the site of insertion of permanent tension free vaginal tape (TVT) the G spot might be affected or the tape might interfere with arousal and sensory stimulation. Recent studies have reported varying degrees of sexual impairment after TVT insertion ranging from 0% to 15% including dyspareunia. Aim The aim of this study was to evaluate sexual function before and after suburethral sling removal due to postoperative female de novo dyspareunia. As a secondary outcome, general patients' satisfaction with their overall continence situation was assessed. Patients and methods Between December 2005 and December 2007, we included 18 female patients who complained of de novo dyspareunia after suburethral sling insertion for urinary stress incontinence. All patients filled in an FSFI questionnaire prior to sling removal and at 3 months postoperatively. Additionally, all women were asked to estimate their general satisfaction regarding their continence situation using a Visual Analogue Scale (VAS) from 0 to 10, with 0 being the least satisfying situation and 10 being the most satisfying situation. All patients underwent gynaecological examination including ICS-pelvic organ prolapse staging (ICS-POP score).Results Of the 18 slings, ten were transobturator tapes (6 9 TVT-O, 2 9 Monarch, 2 9 unknown) and eight were retropubic tapes (7 9 TVT, 1 9 SPARC). Desire, arousal, lubrication, satisfaction, and pain improved statistically significant. Orgasm scores were low with median scoring of 1.5 scores before and 1.0 scores after sling removal, and they did not change significantly after sling removal. The satisfaction rate deteriorated from a median of 7 (95% confidence interval [CI] 6.3-7.7) to a median of 4 (95% CI 3.7-5.1; p = 0.99) but not statistically significant. Conclusions Sexual function in patients with de novo dyspareuina is likely to improve after sling removal but not in all domains. Bladder function may deteriorate.

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“…Tenemos un 12% de complicaciones, siendo la más frecuente la dificultad de vaciamiento vesical (4%) seguida de la perforación vesical (3%), situación inversa a la mayoría de series estudiadas 4,6,10,12,13,14 . Generalmente la dificultad del vaciamiento vesical es un hecho transitorio y es el resultado de la excesiva tensión de la malla o por la colocación del TVT en el contexto de vejiga hipocontráctil, solucionándose normalmente con cateterismos intermitentes durante unos días.…”

Section: Discusionunclassified

“…Generalmente la dificultad del vaciamiento vesical es un hecho transitorio y es el resultado de la excesiva tensión de la malla o por la colocación del TVT en el contexto de vejiga hipocontráctil, solucionándose normalmente con cateterismos intermitentes durante unos días. Si existe obstrucción completa puede ser necesaria la retirada del TVT 3,4,13,15 . En algunos casos este problema podría deberse a la implantación del sistema cerca del cuello vesical 14 .…”

Section: Discusionunclassified

“…Presentamos un caso de hematoma hipogás-trico, complicación relativamente frecuente en el postoperatorio (2-3,3%), generalmente relacionado con sangrado venoso en el espacio retropúbi-co, y que normalmente se resuelven con tratamiento conservador, como en nuestro caso, aunque se han descrito en la literatura hematomas subsidiarios de laparotomía 4,7,13 .…”

Section: Discusionunclassified

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Tratamiento de la incontinencia urinaria de esfuerzo con el sistema TVT: Complicaciones en nuestros primeros 100 casos

Dorado

Fernández

García

et al. 2005

Actas Urológicas Españolas

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PRIMEROS 100 CASOS Introducción: El sistema TVT (Tension-free Vaginal Tape) es la técnica quirúrgica de elección en los últimos años de la incontinencia urinaria de esfuerzo femenina (IUE), dada la facilidad de la técnica, buenos resultados clínicos y escasas complicaciones.Material y métodos: Desde Abril de 1999 a Marzo 2004 se han implantado en nuestro servicio 100 sistemas TVT con revisión de los resultados a los 6 meses, y un seguimiento medio de 10,36 meses (R: 1-54 meses), con una pérdida de seguimiento en el 11% de los casos. Todas las mujeres estudiadas presentaban incontinencia de esfuerzo, siendo la edad media de 56,5 años (30-80). Un 12% habían sido intervenidas previamente de IUE. Presentan cirugía previa del suelo pélvico 21 pacientes. En un 17% de los casos se realizó TVT asociado a otra técnica quirúrgica: 15% cistorrafia anterior, 1% corrección de rectocele, 1% cirugía compleja del suelo pélvico que incluye TVT, corrección de cistocele e histerectomía.Resultados: Obtenemos un 65% de éxitos (comprobación objetiva de la ausencia de escape por parte del médico y referencia subjetiva de la paciente), un 17% de mejoría (disminución clara de escapes por parte de la paciente y mejoría subjetiva) y un 7% de fracaso de la técnica. El porcentaje global de aparición de urgencia de novo posquirúrgica es del 9%. Existieron un 12% de complicaciones; 3 casos (3%) de perforación vesical, 2 de ellos intraoperatorios y 1 diferida junto con infección de la herida quirúrgica; 3 episodios (3%) de residuos altos en el postoperatorio inmediato, resueltos con autosondajes, y un caso de RAO (1%) dado de alta con cistostomía suprapúbica; un caso (1%) de peritonitis química tras retirada de talla vesical resuelta con tratamiento conservador; dos casos (2%) de extrusión vaginal de la bandeleta, con sección de la porción de malla exteriorizada en ambos casos; un (1%) paciente presenta hematoma hipogástrico que se resuelve con medidas conservadoras; un 1 % de los pacientes (1 caso) presentó molestias pélvicas subcrónicas con resolución espontánea.Conclusiones: Consideramos el sistema TVT una técnica quirúrgica eficaz en el tratamiento de la incontinencia urinaria femenina de esfuerzo. Es una técnica sencilla, con baja estancia hospitalaria y escasas complicaciones.Palabras clave: Incontinencia urinaria de esfuerzo. TVT. ABSTRACT TRATMENT OF FEMALE STRESS URINARY INCONTINENCE WITH TVT SYSTEM (TENSION-FREE VAGINAL TAPE): COMPLICATIONSIN OUR FIRST 100 CASES. Introduction: The TVT system is the most common surgical technique of female stress urinary incontinence, because of the simplicity, good clinical results and rare complications.Material and methods: From april, 1999 to march, 2004, it has been done in our department 100 TVT systems with the revision of the result over the six following months. The average follow-up rate was 10, 36 months (R: 1-54 months) and looses mean the 11% of the cases. All the patients presented stress incontinence and their average age was 56,6 years old (30-80). The 12% of the cases have been previo...

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Complications and Untoward Effects of the Tension-Free Vaginal Tape Procedure

Cited by 63 publications

References 9 publications

Presentation and management of major complications of midurethral slings: Are complications under‐reported?

Presentation and management of major complications of midurethral slings: Are complications under‐reported?

Sexual function after suburethral sling removal for dyspareunia

Tratamiento de la incontinencia urinaria de esfuerzo con el sistema TVT: Complicaciones en nuestros primeros 100 casos

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