Complications of tension‐free vaginal tape surgery: a multi‐institutional review

Abstract

blood loss >500 mL in 16 (2.5%). Immediate complications after surgery were urinary retention (>24 h after) in 47 patients (19.7%), pelvic haematoma in four (1.9%) and suprapubic wound infection in one (0.4%). Of the 47 patients in retention, 32 were in retention for <48 h and treated with an indwelling catheter. The 15 remaining patients were treated with an indwelling catheter (one) or clean intermittent catheterization for a mean of 22 days. To correct the retention the TVT was released in seven patients and the tape sectioned in three. Late complications were de novo urgency, persistent suprapubic discomfort and intravaginal tape erosion in 36 (15%), 18 (7.5%) and one (0.4%) patient, respectively. Most of these complications resolved with observation and medical management, but intravaginal tape erosion required partial resection of the tape with closure and repair of the vaginal mucosa. CONCLUSIONSThe present TVT complication rates were slightly higher than reported previously. This multi-institutional review in both academic and community hospitals may better reflect the morbidity of TVT insertion in clinical practice. TVT is a highly effective, minimally invasive method for treating SUI. A stricter definition of each complication and a better understanding of the mechanism of these complications may further improve the surgical outcome and decrease patient morbidity. KEYWORDSurinary incontinence, stress, tension-free vaginal tape, complications, urinary retention, bladder injury OBJECTIVETo analyse the complications of tension-free vaginal tape (TVT) surgery, a minimally invasive alternative for treating patients with stress urinary incontinence (SUI), at six institutions, and to review the management of these complications and their effect on patient outcome. PATIENTS AND METHODSIn all, 241 patients who had a TVT procedure by six urologists at six hospitals (two university and four community) were reviewed retrospectively by the same urologist. Complications during and after surgery, and their management, were analysed.

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

“…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%)…”

Tension-free vaginal tape versus tension-free vaginal tape obturator (inside-outside) in the surgical treatment of female stress urinary incontinence

“…The TVT procedure is more safe and effective surgical treatment of female stress urinary incontinence showing good effectiveness (18)(19)(20)(21)(22), but the TVT procedure is associated with various perioperative complications (23)(24)(25)(26).…”

TVT versus TVT-O for minimally invasive surgical correction of stress urinary incontinence

“…Many authors believe TVT should be considered the gold standard for surgical correction of stress urinary incontinence (2), by virtue of its efficiency featuring up to 81% and 16% complete and partial remission respectively (3). Nevertheless, the technique entails the disadvantage of requiring intraoperative cystoscopy, and consequently it is not free of risks such as bladder, urinary tract and intestinal injury among others (4)(5)(6)(7). In 2001, while in search of a simplified version of the procedure, Delorme (8-10) described the TOT technique (trans-obturator-tape).…”