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Bladder Perforation During Tension-Free Vaginal Tape Procedures: Abdominal Versus Vaginal Approach

McLennan, Mary T. MD*; Barr, Susan A. MD*; Melick, Clifford F. PhD; Gavard, Jeffrey A. PhD*

Female Pelvic Medicine & Reconstructive Surgery:
doi: 10.1097/SPV.0b013e318240d3f6
Original Articles

Objective: Bladder perforation rates for the tension-free vaginal tape (TVT) are higher with inexperienced surgeons. The purpose of this study was to examine if surgical approach affects this rate.

Methods: We performed a retrospective cohort study of consecutive patients undergoing a TVT as the sole procedure. All cases were performed by senior residents using 2 different surgical approaches—vaginal or abdominal trocar passage. Power analysis indicated that 103 patients in each group (vaginal and abdominal approach) were required to demonstrate a 50% reduction in perforation rates.

Results: The rate of perforation was 37.9% (95% confidence interval [CI], 28.5%–47.3%) for the vaginal compared with 6.8% (95% CI, 1.9%–11.7%) for the abdominal technique (P < 0.001). The relative risk that the abdominal technique results in bladder injury compared with the original transvaginal was 0.18 (95% CI, 0.08–0.38).

Conclusions: Bladder perforation occurs significantly less frequently with abdominal needle placement for the TVT procedure. We recommend this technique to less experienced surgeons.

Author Information

From the *Division of Urogynecology, Department of Obstetrics, Gynecology, and Women’s Health, St Louis University School of Medicine, St Louis, MO; and †Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Reprints: Mary T. McLennan, MD, Department of Obstetrics, Gynecology, and Women’s Health, St Louis University School of Medicine, 6420 Clayton Rd, Ste 290, St Louis, MO 63117. E-mail:

The authors declare that they have nothing to disclose.

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