Lateral excision of tension-free vaginal tape for the treatment of iatrogenic urethral obstruction.
OBJECTIVE
To report our experience on lateral excision of tape in women with iatrogenic urethral obstruction after the tension-free vaginal tape (TVT) procedure.


METHODS
Seven women had iatrogenic urethral obstruction based on their clinical and urodynamic findings. All underwent lateral excision of the tape using the vaginal approach. Lower urinary tract symptoms, postvoid residual volume and urodynamic data were evaluated before and after excision.


RESULTS
Before excision, all subjects had either irritative symptoms or increased postvoid residual volume (more than 100 mL), and 6 (85.7%) voided with strain. The mean time from initial surgery to tape excision was 28 days (range 4 to 108), with an average follow-up of 32 months (range 24-39). After the excision, voiding dysfunction was resolved in 6 of 7 patients. The remaining patient had significant improvement with only occasional symptoms of irritation. Two (28.6%) women reported recurrent stress incontinence and 1 (14.3%) required surgical treatment. The intervals for the 2 recurrent patients from TVT to excision were 4 days. The intervals for the 5 continent women were 15 to 108 days.


CONCLUSIONS
Urethral obstruction after TVT is a relatively uncommon condition. It can be effectively treated with transvaginal lateral excision of the tape. Recurrent stress incontinence seems to be less likely to occur when the takedown procedure occurs beyond 14 days after the initial TVT operation.
Long
Cheng-Yu
CY
Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Lo
Tsia-Shu
TS
Liu
Cheng-Min
CM
Hsu
Shih-Cheng
SC
Chang
Yu
Y
Tsai
Eing-Mei
EM
D005260:Female; D006801:Humans; D019736:Prostheses and Implants / Q000009:adverse effects*; D012008:Recurrence; D014524:Urethral Obstruction / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014550:Urinary Incontinence, Stress / Q000628:therapy*; D014563:Urodynamics