Voiding dysfunction after the tension-free vaginal tape procedure.

AIM: To assess the incidence of voiding dysfunction in women undergoing a tension-free vaginal tape (TVT) procedure and report our experience with nonsurgical and surgical management. METHODS: Pre- and postoperative introital ultrasonographic measurement of the residual volume was performed in a prospective observational study. Patients' perception of micturition and continence status was assessed by questionnaire. RESULTS: Of 478 women, 4 (0.8%) suffered from micturition disturbance within the first 2 weeks. In the mean of 3 months after surgery, 7.1% of the patients had residual volume between 50 and 100 ml, and 2.6% had residual volume >100 ml. 243 women were investigated after 39 months (range 12-74). The rate of residual volume exceeding 50 ml decreased to 6.5% and was approximated to the preoperative period. CONCLUSION: Incomplete bladder emptying is a possible problem after TVT. In our cohort, 93% of the women had no voiding disturbances or marginally affected voiding after 12-74 months.

Long-term results of the tension-free vaginal tape procedure in an unselected group: a 7-year follow-up study.

OBJECTIVES: To evaluate long-term effectiveness and late complications after treatment of female stress urinary incontinence with tension-free vaginal tape (TVT). METHODS: We performed a prospective observational study. Follow-up examinations included a standardized questionnaire, medical history, voiding diary, gynecologic examination with cough test, and introital ultrasound. RESULTS: One-hundred-eight women (68.8%) from the initial cohort of 157 patients and 79.6% of those alive and able to cooperate were assessed. The median follow-up time was 102 months (range 85-124). The objective cure rate was 89.8%. The subjective cure rate was 82.4%, 13% had improved, 2.8% regarded the continence situation as unchanged, and 1.8% had an impaired stress urinary incontinence. No late-onset adverse effects of the surgery were found. Urge incontinence was the main reason for dissatisfaction with the surgery (in 90% of discontent patients). CONCLUSIONS: Our data showed good results more than 7 years after TVT, demonstrating a high level of long-lasting efficacy for this minimally invasive incontinence procedure.

Retziusscopy: a minimal invasive technique for the treatment of retropubic hematomas after TVT procedure.

OBJECTIVES: Retropubic hematomas are rare but typical complications during or after the tension-free vaginal tape (TVT) procedure. We investigated the possibility of treating these hematomas with retziusscopy, as an update of a previous study by our group. STUDY DESIGN: Over a 10-year period the clinical course of all 685 consecutive patients undergoing the tension-free vaginal tape procedure (TVT, Gynecare) was prospectively recorded, including management strategies for clinically relevant hematomas. We report on 10 patients with hematoma and our following surgical management. RESULTS: In twenty-eight patients (4.1%) a symptomatic retropubic hematoma developed. In 10 cases (1.5%) volume exceeded 250 mL (range 250-1000 mL). These patients required surgical intervention because of moderate or severe symptoms. In the first case we performed open laparotomy, whereas in the following cases the hematomas could be successfully drained by retziusscopy. CONCLUSIONS: In cases of large masses, intervention may be necessary because of significant discomfort. This can usually be achieved by a minimally invasive retziusscopy.

Pregnancy and delivery after tension-free vaginal tape (TVT) procedure: literature review and case report.

The popularity of the TVT procedure for treating stress urinary incontinence has led to more women of childbearing age undergoing this surgery. Therefore the incidence of pregnancy after TVT procedure is likely to increase. We present a review of the current literature and we report the case of a 26-year-old woman previously treated with TVT-O. In the literature there is no evidence that an elective caesarean section protects against stress urinary incontinence in cases of pregnancy after TVT procedure. In our case an elective caesarean section was performed at 39 weeks' gestation. Postnatal pelvic floor exercises successfully controlled the incontinence with a recurrence of the stress urinary incontinence 4 months after delivery on terminating physiotherapy. At 17 months after delivery the woman remained well with no incontinence or further treatment. In our opinion, vaginal delivery after TVT is not contraindicated. However, the mode of delivery must be considered individually and after fully advising the pregnant woman.

Influence of bladder volume on pelvic organ prolapse quantification results.

AIMS: To compare the degree of pelvic organ prolapse between examinations performed with full and empty bladder in patients without any prolapse and with pelvic organ prolapse stage I or II using the pelvic organ prolapse quantification (POPQ) system. METHODS: A prospective observational study with 120 consecutive patients with and without symptoms of pelvic organ prolapse was evaluated. All women were examined with full and empty bladder. The data were analyzed by Wilcoxon's signed-rank test. RESULTS: With empty bladder 54% had the same stage, 41% had a one-step higher stage and 5% had a two-step higher stage of prolapse. There was an increase in the extent of prolapse in the empty bladder setting at all six site-specific points (Aa, Ba, C, D, Ap, Bp; p < 0.001) but not in the results of genital hiatus, perineal body and total vaginal length. CONCLUSION: Our results suggest that the full extent of prolapse may be only assessed with an empty bladder.

Comparison of transobturator vaginal tape and retropubic tension-free vaginal tape: clinical outcome and sonographic results of a case-control study.

OBJECTIVES: To compare the results and ultrasonographic characteristics of the transobturator vaginal tape (TVT-O) and retropubic (TVT) methods. METHODS: 120 patients were treated with TVT-O. These were paired with similar patients treated with TVT. The patients were matched according to age, low-pressure urethra, preexisting mixed incontinence, and additional prolapse repair. The follow-up time was 3 months. Assessment variables included a standardized questionnaire, medical history, voiding diary, urinary stress test, 24-hour pad test, and introital ultrasound. The position of the tape was defined by its location in relation to urethral length (%) and the narrowness by its distance to the hypoechoic center of the urethra (mm). RESULTS: The rates of postoperative complications including bladder perforation, urinary retention, and erosion through the vagina were similar. The number of hematomas occurring after TVT was insignificantly higher than after TVT-O (5 cases vs. 1 case). The rates for cure or improvement of stress incontinence were 77 and 17% after TVT-O and 85 and 14% after TVT (not significant). The sonographic characteristics were identical. CONCLUSION: In terms of clinical outcome, TVT and TVT-O appear to be equally effective. Complications and sonographic characteristics of the tapes were similar after both procedures.