Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Abstract

Introduction: The midurethral sling has become the current standard for the treatment of female stress urinary incontinence. Aim: To assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures. Material and methods: The analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6-and 12-month follow-up. Results: A significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13-0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16-0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97-6.3; OR = 2.3, 95% CI: 0.95-5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality. Conclusions: TVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.

A retrospective analysis of perioperative complications associated with retropubic tension-free vaginal tape in 960 women

“…The types of specific postoperative complications which occurred, and their frequency are similar to those described in the literature [3,6,10,15,16]. Affecting 41 women, urinary retention and voiding problems were the most frequent complications in our study.…”

“…In comparison to previous studies reporting low numbers of urinary tract infections, making up less than 5% of all complications [14,15] or not reporting a single one [10], our study showed ten urinary tract infections which make up 13.7% of the complications. Several further studies did not refer to urinary tract infections when discussing postoperative complications [16,17].…”

“…With 4 (0.42%) out of the 960 women suffering retropubic hematomas, our rate is slightly lower in comparison to previous studies, reporting 0.78-1.1% of the patients affected [10,11,14,15].…”

“…Several variables differed from those of other studies. With 25 min the mean operative time (TVT only subgroup) is shorter than in other studies, with mean operative times ranging from 30 to 38 min [15,17,20,21]. The mean age of the patients who were affected by complications is significantly higher (3.4 years) than the mean age of the patients with no complications.…”

“…Cases of small residuals can be treated conservatively [18]. Additionally, an intermittent catheterization can be helpful [10,11,15,16,18]. In cases of persistent urinary retention and micturition problems the TVT often has to be mobilized [10][11][12].…”