Tape Related Complications of the Tension-Free Vaginal Tape Procedure

Tsivian, Alexander; Kessler, Oded; Mogutin, Baruch; Rosenthal, Jonathan; Korczak, D; Levin, Samuel J.; Sidi, Avner

doi:10.1097/01.ju.0000106083.51860.ca

Cited by 91 publications

(62 citation statements)

References 18 publications

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“…The published incidence rate of urinary retention after single incision sling surgery for incontinence has been reported to be 3.2% [17]. In another study, the incidence rate of urethral obstruction after synthetic sling surgery for incontinence has been reported to be 20% [18]. In our study, however, urinary retention rate was 3.47%, but none of the patients suffered permanent retention.…”

Section: Discussioncontrasting

confidence: 55%

The Effectiveness and Complications of Double-Forced Sling Method in Stress Incontinence Surgery

Okulu¹,

Ener²,

Aldemir³

et al. 2013

Ann Clin Anal Med

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and Boney test, supine stress test, and urination diary, 24-hour pad test, cystoscopy and urodymanics measurements (cystometry and Valsalva leak point pressure) were recorded for each patient. The patients filled out ICIQ-SF and Korman questionnaires for urinary incontinence.The data of the patients and the success of the operation were evaluated based on 24hr pad test, ICIQ-SF scoring,and Korman questionnaire analysis. Results: The mean age of the patients was 49.7 ± 8.7 years (range: 31-75 years). None of the patients suffered intraoperational complications. In all of the patients, the postoperative 6th,12th, and 48th months ICIQ-SF scores, pad counts and pad test were reached to the statistically significant lower than those of the preoperative period (p<0.05)Postoperatively, in the 48th month, 135 patients (93.75%) had continence rate and the patient satisfaction rates for all patients were as 125 patients (86.8%). Four patients (2.77%) had vaginal extrusion, and 2 patients (1.38%) had urethral extrusion. Four patients (2.77%) had suture granuloma and ten patients (6.94%) had de novo urgency. Discussion: Broad based double forced sling is an effective technique in the treatment of stress urinary incontinence and type of the mesh used in sling surgery is very critical point and further clinical and experimental studies are needed.

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Section: Discussioncontrasting

confidence: 55%

The Effectiveness and Complications of Double-Forced Sling Method in Stress Incontinence Surgery

Okulu¹,

Ener²,

Aldemir³

et al. 2013

Ann Clin Anal Med

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“…The presence of mesh within the bladder may arise either from direct bladder perforation, which is missed at cystoscopy (if done) or from subsequent erosion of a submucosal sling [8]. It is often difficult to distinguish retrospectively between these two events.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are two reports of failed endoscopic removal of cut but adherent tape requiring an open procedure [8,28]. Bladder stones are crushed mechanically or with the lithoclast, while tape is either cut flush with the bladder wall and extracted whole, or resected.…”

Section: Discussionmentioning

confidence: 99%

Unrecognized bladder perforation with mid‐urethral slings

2010

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Study Type – Therapy (case series) Level of Evidence 4OBJECTIVETo present a series of women with late presentation of mid‐urethral synthetic slings perforating the bladder and their management, this is rare but can lead to significant morbidity with medico‐legal consequences.PATIENTS AND METHODSWe retrospectively reviewed the case notes of nine women with urinary symptoms referred to our unit for further investigation after synthetic mid‐urethral sling placement.RESULTSThe women presented between 8 weeks and 18 months after initial sling placement. Eight patients underwent a tension‐free vaginal tape insertion via the retropubic route and one patient had an ‘outside‐in’ obturator sling with the I‐Stop device (CL Medical, Lyon, France). The frequencies of presenting symptoms were: dysuria in six; recurrent urinary tract infection in four; frequency and urgency in four and pelvic pain in two. Seven of the nine women developed bladder calculi on the exposed sling material, all of which were visible on plain X‐ray. In six women, perforations were present at more than one site; in three urethral perforation had occurred together with an anterolateral bladder injury and in the remaining three there was bilateral bladder perforation. Initial management included cystoscopy and cystolithopaxy followed by transurethral resection (TUR) of the visible prolene mesh into the detrusor muscle. One woman required two TURs to clear all the mesh. Two women required further open surgery to remove all of the remaining mesh, both for ongoing pelvic pain that resolved after revision surgery. All the women had resolution of symptoms but all had recurrent stress urinary incontinence after tape division/excision. We used a novel technique to remove intraurethral mesh using a nasal speculum urethrally and excising the tape under direct vision, where resection proved impossible due to poor endoscopic views, with significant risk of sphincter injury.CONCLUSIONSThe possibility of unrecognized tape perforation or erosion must be considered in women with persistent urinary symptoms, infection or pain after any form of mid‐urethral sling procedure. Bladder stones almost invariably develop if the exposed mesh has been present for >3 months. Most patients can be managed with endoscopic resection to remove all intravesical tape. Cystoscopy should remain a mandatory procedure together with any form of mid‐urethral sling placement but does not prevent unrecognized perforations in inexperienced hands.

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“…It has been rapidly gaining popularity worldwide. Recent studies reported high cure rates of 78.9% to 84.7% after long-term follow-up [15,16] and described relatively low intraoperative and postoperative complication rates [17]. However, there are few published short-term studies on the outcomes of the TVT procedure in overweight and obese women [13,[18][19][20].…”

Section: Discussionmentioning

confidence: 99%

Does patient weight influence the outcome of the tension-free vaginal tape procedure?

et al. 2006

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Urinary stress incontinence (USI) is more common in obese women. The influence of obesity on surgical treatment for USI is controversial. We sought to determine whether obesity affects the outcome of the tension-free vaginal tape (TVT) procedure. The retrospective data of 81 women that underwent the TVT procedure between 04/1998 and 12/2000 were studied. The study cohort women (aged 37-87 years) were subdivided into three groups according to body mass index (BMI): normal (BMI = <25)-group 1, overweight (BMI = 25-29)-group 2, and obese (BMI = >30)-group 3. All women underwent preoperative examinations, including detailed medical history and physical examination with stress tests and urodynamic studies. Follow-up included post-procedure check-up meetings at 1, 3, 6, and 12 months and once yearly thereafter (minimal follow-up = 52 months). Intra-and postoperative complications and success rates were compared among the three groups. Twenty-six (32.1%) women had normal BMI, 21 (25.9%) were overweight, and 34 (42%) were obese. Six intraoperative complications were recorded, including 5 bladder injuries and 1 urethral injury, none of which required surgical re-intervention. Eight reported postoperative complications included 1 bladder erosion, 3 urethral obstructions, 4 vaginal erosions (1 patient suffered from concomitant urethral obstruction and vaginal erosion). Five patients diagnosed with postoperative surgical complications underwent corrective surgery. There were no significant intergroup differences among the complication rates. The success rates were 84.6%, 81%, and 79.4% in groups 1, 2, and 3 respectively. Increased BMI may have a slight negative impact on TVT results, but the long-term success rate of 79.4% in obese women and the lack of any direct correlation between BMI and complications sanction their undergoing TVT.

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Tape Related Complications of the Tension-Free Vaginal Tape Procedure

Abstract: Urologists should be aware of the nature and symptoms of tape related complications associated with a TVT procedure for prompt diagnosis and appropriate postoperative management.

Cited by 91 publications

References 18 publications

The Effectiveness and Complications of Double-Forced Sling Method in Stress Incontinence Surgery

The Effectiveness and Complications of Double-Forced Sling Method in Stress Incontinence Surgery

Unrecognized bladder perforation with mid‐urethral slings

Does patient weight influence the outcome of the tension-free vaginal tape procedure?

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