The Techniques of Trocar Insertion and Intraoperative Urethrocystoscopy in Tension-Free Vaginal Taping: An Experience of 600 Cases

Abstract

The author presents his experience with trocar insertion and urethrocystoscopy associated with the tension-free vaginal tape procedure (TVT). Over a 5-year period from November 1995 to March 2001, he performed TVT in 600 women with stress urinary incontinence with or without pelvic prolapse. All patients underwent preoperative urodynamic assessment. In addition, all patients had an intraoperative urethrocystoscopy to ascertain the integrity of the bladder and urethra. A concomitant procedure was performed in 169 (28%) cases. Of 188 women who had undergone previous pelvic surgery, 34 had procedures that posed a significant risk of ureteral injury. These patients were injected with 1% methylene blue solution before cystoscopy to confirm ureteral patency. The study population had a mean age of 53 years (range, 32-76 years) and a mean parity of 2.54 (range, 0-6). Of 270 (45%) women who were menopausal, 140 (51.9%) were taking hormone replacement therapy. Endoscopy findings included identification of 5 patients (0.8%) who had bladder perforation or near perforation that required reinsertion of the trocar. One woman had a biopsy of a benign granuloma. Sutures from a previous retropubic urethropexy were discovered in 1 patient and removed. Another subject required excision of an adhesion band in the urethra, which was placed during a previous excision of urethral diverticulum. A ureteral obstruction resulting from a previous laparoscopic Burch colposuspension was suggested by delayed dye emission in 1 of the 34 women who was injected with intravenous methylene blue dye. Ureteroscopy was performed and a stricture of the right distal ureter was identified and incised with electrocautery. A double-J catheter was inserted and left in place until a patent ureter was established.