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Tip/Trick 4: Voiding Dysfunction in Patients With TVT Slings Adjusted Using an Alternative Method of Tensioning

Pulliam, S J.*; Chelmow, D; Weld, A W.*; Rosenblatt, P L.*

Journal of Pelvic Medicine and Surgery: 2005 - Volume 11 - Issue - p S25-S26
doi: 10.1097/01.spv.0000179147.67583.ae
Tips/Tricks Presentations: AUGS Abstracts: 2005 26th Annual Scientific Meeting of The American Urogynecologic Society

*Mount Auburn Hospital, Harvard Medical School, Cambridge, MA; †New England Medical Center, Tufts Medical School, Boston, MA

Disclosure – Grant/Research Support: TAP Pharmaceutical: D. Chelmow; Consultant: Gynecare: P.L. Rosenblatt; Speaker's Bureau: Pfizer: P.L. Rosenblatt; Other: Cook: P.L. Rosenblatt; Gynecare: S.J. Pulliam

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OBJECTIVE:

Adjusting the tension on a Tension Free Vaginal Tape suburethral sling (TVT) is one of the most subjective, and critical parts of the procedure, with significant impact on its outcome. Placing the sling on too much tension can result in postoperative urgency and frequency, urinary retention and/or the need for a sling revision. Using too little tension may result in failure to cure stress incontinence. We compared 2 tensioning techniques to determine differences in postoperative voiding parameters.

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METHODS:

A retrospective cohort study of all women undergoing retropubic TVT (Gynecare, Somverville, NJ) from September 2003 until January 2005 was conducted. All patients underwent TVT by the same surgeon (PLR). Before June 2004, the TVTs were adjusted by placing a Metzenbaum scissors between the tape and urethra and adjusting the tension prior to removing the plastic sheaths of the sling. After June 2004, the TVT was adjusted by pulling back the plastic sheath at the midline, and grasping a 3 mm fold of mesh using a Babcock clamp. The sling was adjusted by bringing the Babcock clamp into contact with the suburethral tissue, and removing the plastic sheaths. The mesh was then released from the Babcock, allowing the reserved mesh to lie flat underneath the urethra. Outcomes including length of catheterization, uroflow studies, post void residuals and need for further surgery were compared using the student t-test and chi-square test as appropriate.

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RESULTS:

Twenty-three patients underwent TVT placement with Babcock adjustment (TVT-B), and 74 underwent TVT placement with Metzenbaum adjustment (TVT-M). Age and body-mass index, preoperative maximum urethral closure pressures and leak point pressures were not significantly different between groups. Postoperative uroflow parameters were also not significantly different. No patients in the TVT-B group were catheterized for more than 14 days, while 11 (14.9%) of those in the TVT-M group required catheterization for more than 14 days (P=0.050). No patients in the TVT-B group required a procedure to revise the sling. Seven (9.6%) in the TVT-M group required such a procedure (P=0.123).

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CONCLUSIONS:

Using the Babcock adjustment technique for the tensioning of the TVT sling results in fewer patients requiring prolonged catheterization (more than 2 weeks), than adjustment using the traditional method.

© 2005 Lippincott Williams & Wilkins, Inc.