Short-term safety and effectiveness of tension-free vaginal tape (TVT) sling insertion for urodynamic stress incontinence alongside other gynaecological operations

Abstract

The aim of this study was to assess the safety, effectiveness and pattern of inserting tension-free vaginal tape (TVT) slings alongside other gynaecological operations. It was a retrospective case note review of 116 patients who had a range of minor and major vaginal, laparoscopic and abdominal procedures at the same time as having TVT sling insertion at five district general hospitals in the UK. It showed an overall incidence of complications of 22.4% and laparotomy was not required. A patient had bladder perforation, another had blood transfusion, a third had infection at the site of needle passing, and three patients had urinary tract infection. The overall incidence of complications in this series was significantly higher in those having major concomitant surgery than in the total group. Although 9.5% of patients had catheters for more than a week, only two patients (1.7%) required prolonged intermittent self-catheterisation. Development of overactive bladder symptoms was reported by 8.5% of those who had pure urodynamic stress incontinence prior to surgery. Ninety-four per cent of patients were dry at 6 weeks. All major abdominal procedures were carried out under general anaesthesia prior to TVT sling insertion. A considerable variation was observed in operative and anaesthetic technique with all other concomitant procedures. These results demonstrated that TVT sling insertion alongside other minor and major gynaecological procedures did not undermine the safety or effectiveness of TVT sling insertion. Operative and anaesthetic practice varied considerably, calling for randomised controlled trials to provide evidence for best practice.