[Complications of tension-free vaginal tape procedure: a comparison of the vaginal and abdominal approaches].
OBJECTIVE
The objectives of this clinical study is to demonstrate our experience of the abdominal approach (from the abdominal wall to the vagina) for the tension-free vaginal tape (TVT) operation and to identify factors responsible for complications relating to the puncture.


METHODS
One hundred and fifty-one cases of patients with stress incontinence who underwent the tension-free vaginal tape operation were analyzed. Among them, 75 cases underwent the TVT procedure with the vaginal approach (from the vagina to the abdominal wall) and the remaining 76 cases underwent the TVT procedure with the abdominal approach (from the abdominal wall to the vagina). The TVT procedure with abdominal approach was performed in almost the same manner as described in the guiding booklet provided by Gynecare. Student's t-test was used to detect the differences in ages and operating times between the abdominal and vaginal approach cases. Chi-square test was used to analyze the difference between complication rates of the two procedures. Multivariate logistic regression analysis was used to determine the relationship between complications related to the puncture and such factors as age, concomitant operation for genital organ prolapses, approach routes and past history of intra-pelvic surgery.


RESULTS
Differences between the abdominal and vaginal approach cases as regards age of patients and operating time were not significant. Chi-square test showed that the difference between the complication rates of the two procedures was not significant. Complications relating to the puncture consisting of bladder perforation and intra-pelvic hematoma occurred in nine cases in the vaginal approach group. Since an abdominal guide passed very close to the urinary bladder in one case in the abdominal approach group, we counted this as a bladder perforation case. Seven cases out of these ten cases with complications had a past history of intra-pelvic operation. Multivariate logistic regression analysis showed that the risk factors associated with these complications were the vaginal approach procedure [odds ratio (OR) 11.4, 95%confidence interval (CI) 1.4-96.4] and past history of intra-pelvic surgery [OR8.2, 95%CI 1.9-35.5].


CONCLUSIONS
The difference between the complication rates of the two procedures was not sig- nificant. The vaginal approach puncture and the past history of intra-pelvic surgeries were the risk factors for the complications relating to the puncture.
Takeyama
Masami
M
Department of Urology, Osaka Central Hospital.
Noma
Masanori
M
Yamamoto
Keisuke
K
Kiuchi
Hiroshi
H
Hirai
Toshiaki
T
Matsumoto
Minori
M
Nakagawa
Masahiro
M
Koga
Minoru
M
D034861:Abdominal Wall / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D017773:Pelvic Floor; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D011677:Punctures / Q000009:adverse effects*; D013536:Suture Techniques; D014550:Urinary Incontinence, Stress / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*; D014621:Vagina / Q000601:surgery