Use of intravenous anesthesia for tension-free vaginal tape therapy in elderly women with genuine stress incontinence.
OBJECTIVE
To study the efficacy of the tension-free vaginal tape (TVT) procedure for elderly patients.


METHODS
Forty-five women, 65 years old or older (mean 69.1; range 65 to 85), were treated for genuine stress incontinence with the tension-free vaginal tape procedure under intravenous anesthesia with heavy sedation. Urodynamic studies and 1-hour pad test were performed before the procedure and at 1 year postoperatively. Vigorous manual pressure against the abdominal wall and ensuring no lifting of urethra by intraoperative introital ultrasonography were used to position and adjust the vaginal taping.


RESULTS
Forty-one (91%) were cured, one improved, and three failed. No major surgical complications occurred. Two bladder perforations were noted. The pad test disclosed a reduction in urine leakage from a mean of 28.9 to 1.6 g/hr (P <0.001). The average blood loss was 72 mL (range 30 to 250), operating time was 21 minutes (range 18 to 35), and postoperative hospital stay was 24.2 hours (range 12 to 72). Spontaneous voiding with an adequate volume of postvoid residual urine was noted for all patients by the fourth day postoperatively. Urodynamic parameters related to the voiding dysfunction showed no significant difference before and after surgery. De novo detrusor instability was observed in 2 patients.


CONCLUSIONS
With modifications of the technique and the aid of intraoperative ultrasonography, the TVT procedure can be performed under intravenous anesthesia with heavy sedation. The procedure is safe, effective, and minimally invasive for elderly patients. However, long-term follow-up is needed to determine whether this surgery achieves long-lasting results.
Lo
Tsia-Shu
TS
Department of Obstetrics and Gynecology, Division of Urogynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan, Republic of, Taiwan, China.
Huang
Huei-Jean
HJ
Chang
Chia-Lin
CL
Wong
Shu-Yam
SY
Horng
Shang-Gwo
SG
Liang
Ching-Chung
CC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000771:Anesthesia, Intravenous / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D019736:Prostheses and Implants; D016896:Treatment Outcome; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics; D013520:Urologic Surgical Procedures / Q000009:adverse effects