BERKELEY, CA (UroToday Inc.) - Numerous different surgical procedures have been used for the treatment of stress urinary incontinence. The "perfect" procedure, one that is simple, effective, minimally invasive, durable, and complication free, has yet to be developed. The TVT procedure described by Ulmsten and colleagues has become increasingly popular, as it is simple and minimally invasive. The initial effectiveness of the procedure has been good. The lingering questions concerning the use of TVT are its durability and rate of complications.

Abouassaly and colleagues from Quebec, Canada, in the July issue of the BJU International, retrospectively reviewed 286 cases of the TVT procedure to assess complication rates. This was a multi-institutional review that included six hospitals (four community and two university). Six urologists performed the procedures.

Forty-five charts lacked the appropriate data and were not analyzed, leaving a total of 241 cases, which were in the final review. The mean follow up was 147 (60-484) days.

Complications that occurred at the time of surgery included bladder perforation in 14 patients (5.8%) that were managed with simple catheter drainage, and significant bleeding (>500ml) in 6 patients (2.5%).

Urinary retention was the most common perioperative complication. It occurred in 47 women. Of these, 32 had urinary retention for less than 48 hours, while 15 had urinary retention more than 48 hours. Women in retention were generally treated with clean intermittent catheterization for a mean duration of 22 days. Ten of them eventually had to undergo surgical revision of the sling.

Pelvic hematoma was found in 1.9% of women. This was most often diagnosed when retention was coupled with more than expected suprapubic/pelvic pain. One of these required surgical drainage. One woman had a suprapubic wound infection, which was treated with antibiotics.

De novo urgency occurred in 30 patients (15%) after surgery. At one year of follow-up this decreased to 5%. Complications occurring more than three months following the procedure included mild suprapubic discomfort in 7.5%, and vaginal tape erosion in two patients.

The TVT procedure is not without complications, but most can be treated conservatively and only a few required any further surgical intervention. With proper training of the operator, the TVT procedure can be an effective procedure that can be done safely. It provides an alternative to more invasive treatments for female stress urinary incontinence.

BJU Int. 2004; 94:110-113