title: An alternative method of tension-free vaginal tape implantation for the treatment of female urinary incontinence.
abstract: OBJECTIVE
  To present an alternative technique of implanting the tension-free vaginal tape (TVT) to minimize the risk of bladder perforation or major pelvic injuries.
  
  
  METHODS
  Sixteen female patients with stress urinary incontinence were operated on. The procedure was performed under epidural/spinal anesthesia. A vaginal inverted U incision was made. Dissection was performed alongside the urethra bilaterally and the index finger bluntly dissected into the Retzius space after perforation of the endopelvic fascia. The TVT needle was passed through the lower abdominal wall guided by finger. The rest of the procedure was then finished up as originally described.
  
  
  RESULTS
  All patients underwent the operation smoothly without any bladder perforation or major pelvic injury. The mean operative time was 49 (range 32-87) min, and no patient had blood loss >100 ml. All patients could void satisfactorily within 2 weeks. Postoperatively, 94% of the patients (15/16) reported complete dryness, and 6% (1/16) significantly improved. At follow-up after 6 months, the dry rate was 87% (14/16) and the improvement rate 13% (2/16). The 24-hour pad test was significantly improved: preoperatively 112 +/- 43 g; postoperatively 8.5 +/- 4 g (p < 0.001). The maximum flow rate was not significantly reduced: preoperatively 27.1 +/- 8.9 ml/s, postoperatively 24.6 +/- 6.4 ml/s (p > 0.05). No patient had residual urine >50 ml.
  
  
  CONCLUSIONS
  The reported technique offers an alternative way for TVT implantation. The intent is to minimize the risk of major pelvic injury and bladder perforation without compromising the surgical outcomes. Such benefit may outweigh the additional trouble of periurethral dissection.
authors.affiliation: Department of Urology, National Cheng Kung University, College of Medicine, Tainan, Taiwan. yctong@mail.ncku.edu.tw
authors.forename: Yat-Ching
authors.initials: YC
authors.lastname: Tong
mesh_terms: D000328:Adult; D000368:Aged; D001458:Bandages; D005260:Female; D006801:Humans; D019736:Prostheses and Implants; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*