title: [Treatment of urinary stress incontinence using suburethral implantation of tension-free vaginal tape (TVT). 4 years' experience].
abstract: OBJECTIVE
  To analyze our results in terms of continence and complications of treatment of urinary incontinence with TVT during the 4 first years.
  
  
  METHODS
  72 patients underwent surgery for urinary incontinence between 1999 and 2002. Chart review was performed for medical history, physical examination, urodynamic tests, surgical procedure, intraoperative and postoperative complications, objective and subjective results.
  
  
  RESULTS
  62 patients were diagnosed of genuine stress urinary incontinence and 10 patients of mixed urinary incontinence. 14 patients had grade 3 cystocele, 12 of them underwent associated colporrhaphy. Operations were performed under local anaesthesia in 1 patient, spinal anaesthesia in 41 and general anaesthesia in 30. Mean operation time was 32 minutes, 66 minutes when colporrhaphy was associated, and previous surgery did not increase the surgical difficulty. 6 patients (8.3%) suffered bladder perforation which was identified during cystoscopy, but only required reposition of the tape without affecting patients' outcomes; 1 patient had a pelvic hematoma that evolved without sequel; 16 patients (22.22%) had urinary retention which spontaneously resolved between 2 and 60 days, except one case that required section of the mesh. 8 patients (11.11%) developed de novo bladder instability; there were 2 cases of late mesh perforation into urethra or bladder, which were solved by endoscopic mesh section; 3 patients had voiding discomfort and 1 chronic perineum pain. 70 patients (97.3%) achieved continence under stress; nevertheless only 57 patients (79.17%) were satisfied with their outcomes. Main causes for dissatisfaction were failure, de novo instability, persistence of urgency in cases of mixed incontinence, and voiding discomfort. Previous surgery and performance of associated procedures did not influence outcomes, although they were associated with longer operation times and higher incidence of urinary retention. Patients with Valsalva's leak point pressure < 60 H2O cm had slightly worse outcomes (63.5% satisfaction).
  
  
  CONCLUSIONS
  TVT is an easy to learn and easy to perform technique, with few complications and good results.
authors.affiliation: Servicio de Urología, Hospital Universitario Valdecilla, Santander, Cantabria, España. jlgb@ono.com
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Gutiérrez Baños
authors.forename: Bernardo
authors.initials: B
authors.lastname: Martín García
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Portillo Martín
authors.forename: Jose Ignacio
authors.initials: JI
authors.lastname: del Valle Schaan
authors.forename: Rafael
authors.initials: R
authors.lastname: Hernández Rodríguez
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Correas Gómez
authors.forename: Antonio
authors.initials: A
authors.lastname: Roca Edreira
authors.forename: Alberto
authors.initials: A
authors.lastname: Hernández Castillo
authors.forename: Francisco
authors.initials: F
authors.lastname: Ruiz Izquierdo
authors.forename: Carmen
authors.initials: C
authors.lastname: Aguilera Tubet
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019736:Prostheses and Implants; D012189:Retrospective Studies; D001745:Urinary Bladder Diseases / Q000150:complications / Q000601:surgery; D014550:Urinary Incontinence, Stress / Q000209:etiology / Q000601:surgery*; D014563:Urodynamics