The techniques of trocar insertion and intraoperative urethrocystoscopy in tension-free vaginal taping: an experience of 600 cases.
BACKGROUND
To determine the frequency of lower urinary tract (LUT) injury for stress incontinent women undergoing the tension-free vaginal tape (TVT) procedure with or without concomitant procedures.


METHODS
Over a period of 5 years, 600 women who had stress urinary incontinence (SUI), with or without pelvic prolapse, consecutively underwent the TVT procedure either with or without concomitant surgery. All study subjects underwent intraoperative transurethral urethrocystoscopy. During the examination 34 (6%) women at high risk of ureteral injury also received intravenous injection of 6 mL of diluted methylene blue to observe the patency and function of the ureter as well as the integrity of the bladder.


RESULTS
The mean patient age was 52.75 years (range 32-76) and mean parity was 2.54 (range 0-6). Of the 600 women, 188 (31.4%) had had previous surgery, 169 (28.2%) had concomitant surgery, and 9 (1.5%) had abnormal urethrocystoscopic findings. These findings included one case each of previously placed suspension sutures, granuloma-like tissue in the bladder, a delayed dye emission from the ureteric orifice, an adhesive band in the urethra, three cases of perforation of the bladder by the trocar and two cases of an area of thin bladder mucosa. The bladder perforation rate related to the TVT device was 0.8% (5/600).


CONCLUSIONS
Based on the data of this 5-year review, and a high rate of bladder injury (0-25%) reported in the literature, intraoperative urethrocystoscopy is imperative in the TVT procedure, although the rate of bladder injury was only 0.8% in the present study.
Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Chang Gung University, School of Medicine, Taoyuan, Taiwan. alexwang@cgmh.org.tw
Alex C
AC
Wang
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003558:Cystoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013526:Surgical Mesh; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014596:Uterine Prolapse / Q000175:diagnosis / Q000601:surgery*