title: Tension-free vaginal tape for stress urinary incontinence: Is there a learning curve?
abstract: OBJECTIVE
  To assess the learning curve characteristics of the first 30 tension-free vaginal tape (TVT) procedures carried out in our medical center and to evaluate its safety and short-term effectiveness.
  
  
  METHODS
  A total of 30 incontinent women with urodynamically proven SUI were enrolled. None had undergone any previous anti-incontinence procedure. All were operated on by one surgeon, in accordance with the technique described by Ulmsten et al. in 1996. Mean follow-up was 11.4+/- 3.6 months (range, 5-17 months).
  
  
  RESULTS
  Five (17%) bladder perforations occurred at the beginning of the study, due to inadvertent insertion of the applicator. All perforations were identified by intraoperative cystoscopy. Five other patients (17%) had increased intraoperative bleeding (>200 mL) necessitating vaginal tamponade. Blood transfusions were not required. Eight (27%) patients had immediate postoperative voiding difficulties, necessitating catheterization for 2-10 days, but none needed long-term catheterization. There was no local infection or rejection of the Prolene tape was found. All patients were subjectively cured of their stress incontinence; however, urodynamic evaluation revealed "asymptomatic genuine stress incontinence" in one patient. Sixteen of 21 patients (80%) with preoperative urge syndrome, had persistent postoperative symptoms. No patient developed de novo urge incontinence.
  
  
  CONCLUSIONS
  The TVT operation is a new, minimally invasive surgical procedure with excellent short- and medium-term cure rates. However, there is a definite learning curve, and we believe that the operation should only be performed by experienced surgeons.
authors.affiliation: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. agroutz@yahoo.com
authors.forename: Asnat
authors.initials: A
authors.lastname: Groutz
authors.forename: David
authors.initials: D
authors.lastname: Gordon
authors.forename: Igal
authors.initials: I
authors.lastname: Wolman
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Jaffa
authors.forename: Menachem P
authors.initials: MP
authors.lastname: David
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Lessing
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D002983:Clinical Competence; D005260:Female; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D011126:Polypropylenes; D001743:Urinary Bladder / Q000293:injuries; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D014555:Urination Disorders / Q000209:etiology; D014950:Wounds, Penetrating / Q000209:etiology
chemical_list: D011126:Polypropylenes