Combined Tension-Free Vaginal Tape and Prolapse Repair under Local Anaesthesia in Patients with Symptoms of Both Urinary Incontinence and Prolapse

Abstract

Objective: To study the combination of tension-free vaginal tape (TVT) and prolapse repair under local anaesthesia in patients suffering from stress incontinence and prolapse. Study Design: The study was designed as a prospective, open, nonrandomized study. A standardized protocol was used for pre- and postoperative evaluation. Check-ups were performed after 2, 6, 12 and 24 months. The protocol included medical history, stress test (supine and standing position with a comfortably filled bladder), life quality assessment including a visual analogue scale, 24- to 48-hour pad test, and 48-hour micturition diary. Patients: In total 32 patients participated. All suffered from urinary stress incontinence (grade 1–3) and prolapse (grade 1–3). 2 patients had previously undergone surgery 2 and 3 times, respectively, for urinary incontinence with methods other than TVT (traditional anti-incontinence surgery). 3 patients had a history of total hysterectomy. 1 patient had a large rectocele with urinary and faecal incontinence. Mean age was 54 (range 31–74) years, mean parity 2 (range 0–5), and mean duration of incontinence 13 (range 2–29) years. Surgical Technique: TVT was carried out according to the standarized technique as originally described. The prolapse repair included anterior and/or posterior colporrhaphy. All operations could be performed under local anaesthesia. Results: 30 of 32 patients (93%) were cured. One patient (3%) was considerably improved, and 1 patient (3%) was considered a failure. Mean urinary leakage in 24 h was 96 (range 12–355) g preoperatively, and postoperatively 2.7 (range 0–28) g. Mean intraoperative bleeding was 75 (range 25–300) ml. Mean residual urine preoperatively was 15 (range 0–85) ml, and postoperatively 7 (range 0–40) ml. The mean stay in hospital after surgery was 2 (range 1–5) days. No postoperative urinary retention, no defective healing, and no tape rejection occurred. There was one uneventful bladder perforation in a patient who had previously undergone traditional incontinence surgery. This patient left the hospital the day after surgery without postoperative catheterization. Conclusion: The study clearly demonstrates that TVT can be combined with prolapse surgery to effectively treat symptoms of prolapse and urinary stress incontinence.