Tension-free vaginal tape for stress urinary incontinence: Is there a learning curve?
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.
Groutz
Asnat
A
Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel. agroutz@yahoo.com
Gordon
David
D
Wolman
Igal
I
Jaffa
Ariel J
AJ
David
Menachem P
MP
Lessing
Joseph B
JB
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
D011126:Polypropylenes