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The purpose of the study was to determine the intraoperative and immediate postoperative complications of tension-free vaginal tapes (TVTs) and risk factors contributing to these.
The study was a retrospective cohort study of 778 TVT procedures.
The intraoperative and postoperative complications from the study are as follows: Intraoperative complic...
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Stress urinary incontinence (SUI) negatively influences sexual functions. However, the available data on sexual activity of patients who underwent midurethral sling (MUS) implantation are inconsistent. Our aim was to evaluate the impact of MUS implantation on sexual functions of women with SUI. We enrolled 171 patients undergoing the MUS procedure....
Introduction:
This study aimed to evaluate the effects of transobturator tape (TOT) on overactive bladder (OAB) symptoms and quality of life.
Materials and methods:
Patients with stress-predominant mixed urinary incontinence (MUI) who had undergone TOT procedures were considered candidates for this research. Preoperative assessment included anam...
Assessment of the success rates and complications of inside-out technique of Trans-Vaginal Tape (Obturator) (TVT-O) for treatment of stress urinary incontinence (SUI) in women with utero-vaginal prolapse.
A total of 30 consenting subjects with SUI and utero-vaginal prolapse were subjected to TVT-O surgery. These subjects were closely monitored for...
The aim of this study was to evaluate perioperative morbidity and shortterm efficacy of TVT-Secur in treating female stress urinary incontinence. Data from 147 patients with urodynamic and/or occult SUI who were treated with TVTsecur in each single centre between 1st March 2007 and 31st December 2007 were collected. In positioning the sling, 74.8%...
Objective. To determine baseline variables associated with urgency urinary incontinence (UUI) in women presenting for stress urinary incontinence (SUI) surgery. Methods. Baseline data from two randomized trials enrolling 1,252 women were analyzed: SISTEr (fascial sling versus Burch colposuspension) and TOMUS (retropubic versus transobturator midure...
Citations
... Only three surgeons at a time have been performing the MUS procedure in our department. In this way, the volume has been kept high for the surgeons, which has previously been shown to reduce complications [18,19]. Over time, we have employed the same procedure to treat POUR and vaginal sling exposures [16,17]. ...
... Regarding complications on the MUS procedure, our data are comparable with previously reported data [12,15,19]. The chosen treatment for the complications is also in line with these data. ...
Introduction and hypothesis:
The most common complications to midurethral sling (MUS) operations for stress urinary incontinence are postoperative urinary retention (POUR), vaginal MUS exposure, and urgency. They are well described but consensus regarding their management is missing. An evaluation of the treatment of POUR, exposure and urgency after the MUS procedure in our department was implemented. Incontinence status after treatment of complications was evaluated.
Methods:
A review of the medical records of women undergoing MUS procedures from 1 January 2017 to 31 December 2021 (n = 329).
Results:
A total of 279 women (85%) had no complications. Fifty women had one or more complications. Twenty-three women (7%) experienced POUR. Final treatment in 9 women was clean intermittent self-catheterization (CISC). All remained continent. Nine women had the MUS mobilized. This was successful in 8 women who remained continent. Six women had their MUS incised (one after unsuccessful mobilization). Four became incontinent again and 2 remained continent. Eight women had vaginal MUS exposure. Seven attempted recovering of the MUS. This was successful in 3 patients. The remaining had a partial MUS removal. Only 33% remained continent after removal. Ten patients developed de novo urge, but only 2 needed medication.
Conclusions:
Mobilization of the MUS must be considered the optimal treatment for POUR when CISC fails. It is the most effective intervention with the best effect on POUR and the lowest risk of incontinence. Concerning vaginal exposure, a trial of recovering should be attempted as the risk of incontinence when undergoing a partial removal of the MUS is considerable.
... The way how the intraoperative bladder injuries were handled matches with descriptions in the literature. If during the operation, a bladder perforation had been detected by cystourethroscopy the operation was continued in the majority of cases, and the patient was supplied with a catheter postoperatively [13,14]. In case of an extended lesion the operation was stopped [10]. ...
... 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]. ...
Purpose
The purpose is to analyse perioperative complications associated with the retropubic tension-free vaginal tape (TVT) procedure and their management.
Methods
This retrospective, monocentric cohort study included 960 women after retropubic TVT procedure performed by one surgeon from 2011 to 2016. Complications were identified up to 6 weeks after the procedure, divided into specific and general complications and classified based on the Clavien–Dindo (CD) Classification. A visit 6 weeks after the surgical procedure was attended by all patients.
Results
77 complications, of which 74 occurred postoperatively and 3 intraoperatively, affecting 72 (7.5%) out of 960 women. Urinary retention and voiding problems were the most common complication. The mean age of women suffering complications was 3.4 years higher in comparison to the mean age of women without complications ( p = 0.036). The Body Mass Index (BMI) of the group of women with perioperative complications had an average BMI which was 0.5 kg/m ² lower than the average BMI of the women without complications. 22 (12.8%) out of 172 women with recurrent stress incontinence had postoperative complications, of which 21 were related to the TVT.
Conclusion
The retropubic TVT is a surgical procedure associated with a low number of perioperative complications, even in the group of elderly and overweight women, as well as in cases of recurrent stress incontinence.
... 62 Due to the proximity of the bladder nearby the use of the retropubic midurethral sling with TVT has a higher risk of bladder injury than with TVT-O. 63 Other complications of TVT include urinary tract infections, urinary tract lesions and abnormal bladder voiding (post-voiding bladder residue of more than 150 ml). Occasionally, during the placement of the sling due to the passage of the guide trocar in the retropubic space, vascular and intestinal complications may occur, lesions may occur, the risk of which is increased in women who have had previous abdominal or pelvic surgery. ...
Introduction
Stress urinary incontinence (SUI) can be defined as involuntary and unintentional loss of urine through the urethra when vesical pressure exceeds the urethral sphincter pressure during instances of coughing, sneezing or physical exercise. Stress urinary incontinence is the most common form of incontinence in females with an estimated prevalence of 4.5–53% in adult women with urinary incontinence. Yet despite its distressing nature and a negative impact on quality of life, very few women present with their symptoms to a urologist.
Materials and methods
A literature search of the MEDLINE, Cochrane Library, Embase, NLH, ClinicalTrials.gov and Google Scholar databases was done up to November 2020, using terms related to SUI, medical therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence, mid-urethral sling, tension-free vaginal tape and trans obturator tape. The search included original articles, reviews and meta-analyses.
Conclusion
Current guidelines for the management of stress urinary incontinence propose a step-ladder pattern, based on treatment invasiveness starting from conservative therapies, then drugs followed by minimally invasive procedures and culminating in invasive surgeries. The surgical approach is to be considered only after conservative therapies fail. The recent advances in the treatment of stress urinary incontinence have brought to light newer modalities and newer technologies that can be utilized which include laser therapy, stem cell therapy, intravesical balloon and others that show a lot of promise. This paper provides an in-depth analysis and reviews the literature on the current modalities and the future prospects of female stress urinary incontinence.
Level of evidence
Not applicable for this review article.
... 4,5,8 Existing evidence has shown an increased risk of bladder perforation when the surgeon is a "beginner". [9][10][11][12][13] In the TVT procedure, the decreasing rate of bladder perforation as a function of the increasing number of procedures performed has been defined as a possible measure of surgeons' experience. 3 However, studies that have assessed surgeons' experience used very different cut-off values to test that experience, <16, <30, <50 or <100 surgeries. ...
... 3 However, studies that have assessed surgeons' experience used very different cut-off values to test that experience, <16, <30, <50 or <100 surgeries. 3,10,12 The literature is also inconclusive regarding the surgeon's learning phase when studying urinary retention (UR) 11,14 and other perioperative complications. 1,2,5,8,15 At a 2-and 4-year follow up, two studies reported reduced cure rates in low-vs high-volume departments and when comparing low-vs high-volume TVT surgeons. ...
Introduction:
The retropubic tension-free vaginal tape procedure has been the preferred method for primary surgical treatment of stress and stress-dominant mixed urinary incontinence in women for more than 20 years. In this study, we assessed associations between surgeon's experience with the primary tension-free vaginal tape procedure and both perioperative complications and recurrence rates.
Material and methods:
Using a consecutive case-series design, we assessed 596 patients treated with primary retropubic tension-free vaginal tape surgery performed by 18 surgeons from 1998 through 2012, with follow-up through 2015 (maximum follow-up time: 10 years per patient). Data on perioperative complications and recurrence of stress urinary incontinence from medical records was transferred to a case report form. Surgeon's experience with the tension-free vaginal tape procedure was defined as number of such procedures performed as lead surgeon (1-19 ("beginners"), 20-49, and ≥50 procedures). All analyses were done with a 5% level of statistical significance. We applied the Chi-squared test in the assessment of perioperative complications. The regression analyses of recurrence rate by number of tension-free vaginal tape procedures performed were restricted to the three surgeons who performed ≥50 procedures.
Results:
We found a significantly higher rate of bladder perforations (p = 0.03) and a higher rate of urinary retentions among patients whose tension-free vaginal tape procedures were performed by "beginners" (p = 0.06). We observed a significant reduction in recurrence rates with increasing number of tension-free vaginal tape procedures for one surgeon (p = 0.03).
Conclusions:
Surgeon's experience with the tension-free vaginal tape procedure is associated with the risk of bladder perforation and urinary retention, and may be associated with the long-term effectiveness of the procedure.
... The reported complication rate ranges between 3.5% and 6.6%. [10][11][12][13][14] In this audit, the number of bladder injuries was higher at 12.5%. None of these were complete perforations of the bladder wall and all women were discharged same day without sequelae. ...
... The reported rates of voiding dysfunction vary from 19.7% to 47% of cases, depending on the definition and diagnostic criteria used. [12,13] In our practice, incomplete bladder emptying was defined as failed trial of void. We did not look at other factors that may have contributed to voiding dysfunction, such as pain. ...
... It is also the most common complication of TVT at a rate of 3.5-6.6% [24][25][26][27]. In a study that compared TVT and pubovaginal sling with synthetic mesh, the rate of bladder perforation was 4.3% in TVT patients and 0% in pubovaginal sling patients (p=0.287) ...
... The use of the retropubic mid-urethral sling (RP-MUS) with TVT has a higher risk of bladder injury than with TVT-O [23]. Other possible complications of TVT are urinary tract lesions, urinary tract infections and abnormal bladder voiding (defined as a post-voiding bladder residual of more than 150 ml). ...
... Both TVT and TVT-O are associated with high long-term success rates [29], with similar results between the two techniques, as demonstrated by a recent Italian meta-analysis of 49 studies [30]. However, there are differences in the complications associated with the TOT and TVT procedures; for example, retropubic MUS has a higher rate of bladder perforation than TVT-O [23,30]. Moreover, in the UK and elsewhere there has been publicity, and legal action, relating to a small percentage of women undergoing TVT procedures who have had complications such as erosion and pain. ...
Stress urinary incontinence (SUI) is a condition characterized by an involuntary loss of urine occurring as result of an increase in intra-abdominal pressure due to effort or exertion or on sneezing or coughing. Estimates of its prevalence in the female population range from 10% to 40%. A literature search of the Medline, Cochrane library, EMBASE, NLH, ClinicalTrials.gov and Google Scholar databases was done up to July 2017, restricted to English-language articles, using terms related to SUI, medical therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence, mid-urethral sling, tension-free vaginal tape (TVT) and transobturator tape (TOT, TVT-O). Original articles, reviews and meta-analyses were included. Surgical therapy should be considered only after conservative therapies (e.g. an exercise programme or topical estrogens) have failed. Synthetic mid-urethral slings are the gold standard for the surgical treatment of SUI according to the 2016 guidelines of the European Society of Urology (ESU) and the 2017 position statement of the European Urogynaecological Association (EUA). The therapeutic options are numerous but further research into new therapeutic strategies is needed to achieve a better balance between efficacy and adverse events.
... Navedene tehnike su postale metodom izbora kirurškog liječenja za brojne pacijentice 7 . Sve kirurške sling metode podrazumijevaju strogo poštovanje pravila asepse te korištenje jednokratnih, tvornički pripremljenih sterilnih setova za aplikaciju koji uključuju potrebne igle vodilice te polipropilensku traku isprepletenu poput mrežice, kao što je prikazano na slici 3. Kirurške sling Najčešće intraoperativne te kratkoročne komplikacije sling operacija uključuju krvarenja uz nastanak hematoma, potom ozljede mokraćnog mjehura i/ili uretre, opstrukciju mokraćne cijevi te infekcije, dok dugoročne najčešće uključuju pojavu erozije polipropilenske trake te de novo urgentnu inkontinenciju 8,9 . Usprkos svemu navedenom važno je napomenuti da trenutno sling metode predstavljaju zlatni standard u liječenju stresne urinarne inkontinencije u žena. ...
Urinary incontinence is defined asinvoluntary leakage of urine and represents medical, hygienic, social problem. Symptoms range from occasional discreate urinary incontinence to compleate inability to control micturition. Stress urinary incontinence along with urge and mixed are the most common types of urinary incontinence in women. Urinary incontinence represent significant yet underdiagnosed and underreported health problem to huge number of our patients which are still reluctant to seak professional medical treatment due to embarrassment, fear of stigmatisation and unawareness of therapy options. © 2017, Croatian Medical Association and School of Medicine. All rights reserved.
... Complication levels after the procedure are acceptable. In a retrospective study after the complications of TVT by Kristensen et al. [43], 778 procedures were analyzed. The most common intra-operative complication was bladder perforation (6.6%). ...
Stress urinary incontinence is not a deadly disease, but for the large population of women suffering from it, it is a very important issue. Especially in the continuously aging population all over the world, there is more and more need for treatment of this serious medical condition. Treatment of female stress urinary incontinence exists already for ages. In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments. The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers. Luckily there are many options available and the field is developing quickly. In recent years many new medical devices have been developed, that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications. This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.
... V oiding dysfunction is common after pelvic organ prolapse (POP) and urinary incontinence (UI) surgery. [1][2][3][4][5] Investigators have examined many potential risk factors for postoperative voiding dysfunction without success, [6][7][8] making this condition hard to predict in individual patients. Consequently, surgeons who perform pelvic reconstruction or anti-incontinence surgery often use a voiding trial to evaluate bladder function postoperatively. ...
The aim of this study was to evaluate the feasibility of teaching clean intermittent self-catheterization (CISC) in an outpatient setting to women planning surgery for pelvic organ prolapse (POP) and/or urinary incontinence (UI).
This was a prospective observational study of 55 women who planned surgical correction of POP and/or UI. All women were taught CISC as part of their preoperative education. The ability to learn CISC and the amount of time needed to teach CISC were recorded. Multivariate modeling, χ test, Fisher exact test, and Kruskal-Wallis analysis of variance were used for statistical analysis.
Of the 55 subjects consecutively enrolled, 51 subjects (93%) were able to learn CISC and demonstrate competency (P < 0.00001). Four subjects (7%) were unable to learn CISC. The median time to teach CISC with demonstrated proficiency was 3.7 minutes (range, 1.8-7.4 minutes). Of the subjects who learned CISC and had surgery, the mean (SD) time in days from preoperative teaching to the postoperative voiding trial was 16 (11) days (range, 2-39 days). Of the 41 subjects who completed the postoperative voiding trial and had data recorded, 33 (80%) were able to self-catheterize without nurse assistance or with minimal verbal coaching, whereas 8 (20%) subjects required hands-on nursing assistance or were unable to perform CISC (P < 0.001).
Clean intermittent self-catheterization can be taught to most patients undergoing POP/UI surgery in a short time (median, 3.7 minutes). The overwhelming majority of patients are able to retain the CISC skill weeks after being taught in the clinic.
