HEIDELBERG, Germany (Reuters Health) - A new study confirms a low risk of infection following insertion of a synthetic tension-free vaginal tape (TVT) sling to treat stress urinary incontinence.

The investigators say their data, presented at the annual meeting of the International Continence Society here, mean that liberal perioperative antibiotic prophylaxis is not necessary following uncomplicated TVT procedures.

Drs. Suzette E. Sutherland and Howard B. Goldman, with Case Western Reserve University School of Medicine in Cleveland, Ohio, assessed the need for postoperative antibiotic use following uncomplicated placement of the TVT in 58 consecutive women with stress urinary incontinence. Most patients underwent a simple outpatient sling insertion, while some underwent concomitant pelvic reconstructive surgery for genitourinary prolapse.

All women received an immediate preoperative dose of intravenous antibiotics, and 14 of them received additional prophylaxis involving oral antibiotics for a mean of three postoperative days.

No patient developed a symptomatic urinary tract infection or surgical wound infection throughout the four-week follow-up period.

Dr. Sutherland told Reuters Health that a single preoperative dose of intravenous antibiotics is adequate prophylaxis against perioperative surgical infections in these cases. In fact, additional postoperative antibiotics are not only unnecessary in uncomplicated procedures but may also contribute to the development of microbial resistance.

At present, patients often receive a 3- to 7-day course of antibiotics after such procedures. In some cases, they receive a full 2-week course, she noted. The practice is based on concern about the potential for complications resulting from a graft infection related to placement of a synthetic material. The results of this trial, she said, indicate that such concern is unfounded in uncomplicated synthetic sling procedures.

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