Transobturator tape procedure with and without concomitant vaginal surgery.

PURPOSE: We evaluated results and complications of the transobturator tape procedure for female stress urinary incontinence and assessed the effect of concomitant vaginal surgery on the outcome. MATERIALS AND METHODS: We prospectively studied consecutive women who underwent the transobturator tape procedure without (group 1) or with (group 2) concomitant vaginal surgery at our institution from 2003 to 2006. Followup was at least 12 months. Preoperative evaluations included medical history, Urogenital Distress Inventory-6, physical examination, urinalysis and culture, and urodynamics. The procedure was performed as an out-in technique. Therapeutic success was defined as complete continence not requiring pad protection. All other outcomes were classified as failures. RESULTS: A total of 96 patients with a mean age of 63 years (range 37 to 89) who fulfilled study entry criteria comprised the study cohort. Group 1 included 35 patients and group 2 included 61 with 1 or more concomitant vaginal surgeries, including hysterectomy in 28, anterior colporrhaphy in 61, posterior colporrhaphy in 11, and excision of a vaginal granuloma with suture thread and excision of the eroded part of the tape in 1 each. There were no intraoperative complications. One patient per group had transient leg pain. Seven group 2 patients had voiding dysfunction, of whom 3 underwent tape release for a presumed obstructed urethra. Postoperatively 29 women (82.86%) in group 1 and 52 (85.2%) in group 2 were continent throughout the 36.1-month followup (range 12 to 54). CONCLUSIONS: Transobturator tape is safe and effective for stress urinary incontinence. Voiding dysfunction is more prevalent after concomitant vaginal surgery but that surgery does not affect the transobturator tape continence outcome.

Tension-free vaginal tape procedure for the treatment of female stress urinary incontinence: long-term results.

PURPOSE: The tension-free transvaginal tape (TVT) procedure has apparently become the most popular technique for genuine stress urinary incontinence (GSUI). Long-term followup data on the outcome of the procedure are sparse. We evaluated the long-term results of TVT for treating women with GSUI. MATERIALS AND METHODS: We performed a retrospective analysis of the records of 55 patients 37 to 83 years old (mean age 63.4) with GSUI, for which they underwent the TVT procedure at our department as of December 1999. RESULTS: Of the 52 patients who were followed a mean of 55 months (range 48 to 65) 41 (78.9%) were dry. There were 4 intraoperative complication (7.3%), including bladder injury in 3 patients and urethral injury in 1. None required surgical re-intervention. Urgency was reported in 6 women (11.5%). There were 5 postoperative tape related complications (9.6%), consisting of bladder erosion in 1 woman, vaginal erosion in 2 and an obstructed urethra in 2. Four of these 5 women underwent corrective surgery, after which all remained dry. CONCLUSIONS: TVT is a safe and effective procedure for female stress urinary incontinence with an enduring, high success rate. There is a significant rate of intraoperative complications, which do not cause further problems when identified and treated during surgery. One must be alert to the significant rate of postoperative complications that usually require repeat surgery, which is relatively simple and causes practically no long-term morbidity. It also does not influence the continence rate in most cases.

Tape related complications of the tension-free vaginal tape procedure.

PURPOSE: The tension-free vaginal tape (TVT) procedure is a recent modality for managing female stress urinary incontinence. While this procedure is rapidly gaining popularity worldwide, little has been written about its complications. We describe our experience with diagnosing and treating tape related complications following the TVT procedure. MATERIALS AND METHODS: During the last 4 years 12 patients underwent and 1 is scheduled for additional surgery for complications resulting from the TVT. Another patient is only being observed. Their records were reviewed to retrieve data on presenting symptoms and signs, diagnostic tests, surgical procedures and outcomes. RESULTS: One patient had tape erosion into the bladder, 5 had vaginal tape erosion (concomitant urethral obstruction in 1) and another 8 had an obstructed urethra. The more common presenting symptoms were persistent urethral pain, recurrent urinary tract infection, urgency, urge incontinence and vaginal discharge. A total of 12 patients required partial tape removal or tape incision, which was done transvaginally in 11. The remaining patient underwent cystotomy and excision of the intravesical part of an eroded tape. One patient is awaiting corrective surgery and 1 with asymptomatic vaginal erosion is only being observed. No formal urethrolysis was performed in any case. Mean followup after corrective surgery in 12 patients was 4.8 months (range 1 to 30), during which 10 remained continent and all 12 were symptom-free. CONCLUSIONS: 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.