Since its introduction about a decade ago, the tension-free vaginal tape (TVT) operation has been the most widely used surgical procedure for treating women with stress urinary incontinence. Postoperative voiding dysfunction is reported in 1.5% to 14% of patients, and there is, as yet, no consensus on how best to manage those affected. The investigators reviewed 143 patients having a TVT procedure in the years 1998–2005. In all cases, it was the only surgery performed and was carried out as originally described by Ulmsten. No vaginal pack was used after the operation and, in the absence of bladder perforation, the catheter was removed at the end of surgery. If a bladder scan the next morning disclosed more than 100 mL of residual urine, the patient was asked to perform clean intermittent catheterization (CIC) at home. Prolonged voiding dysfunction was defined as a need for CIC for longer than 1–2 weeks postoperatively accompanied by a feeling of incomplete emptying.
Three bladder perforations occurred, all of them within a year of introduction of the operation. Two of the 143 patients, 1.4% of the total, had stress incontinence 3 months postoperatively. Ten patients (7%) had prolonged voiding dysfunction despite a lack of intraoperative complications. Only one of them had a history of urogynecological surgery—an anterior repair. Urodynamic studies proved stress incontinence in all 10 patients. In five instances, the tape was pulled down by about 5 cm, and all these patients remained dry. Incontinence recurred in 2 patients when the tape was cut. Three patients performed CIC for periods ranging from 5 weeks to 9 months, but some degree of prolonged voiding and/or urgency persisted in all of them.
When voiding dysfunction is present following the TVT procedure, the tape should be pulled down after 1 to 3 weeks. Cutting the tape entails a risk that incontinence will recur. Prolonged CIC may result in slow urine flow and a need for double voiding.
Department of Gynecology and Obstetrics, Aalborg Sygehus, Aalborg, Denmark
Acta Obstet Gynecol 2006