title: Bladder perforation during tension-free vaginal tape procedures:  abdominal versus vaginal approach.
abstract: OBJECTIVE
  Bladder perforation rates for the tension-free vaginal tape (TVT) are higher with inexperienced surgeons. The purpose of this study was to examine if surgical approach affects this rate.
  
  
  METHODS
  We performed a retrospective cohort study of consecutive patients undergoing a TVT as the sole procedure. All cases were performed by senior residents using 2 different surgical approaches-vaginal or abdominal trocar passage. Power analysis indicated that 103 patients in each group (vaginal and abdominal approach) were required to demonstrate a 50% reduction in perforation rates.
  
  
  RESULTS
  The rate of perforation was 37.9% (95% confidence interval [CI], 28.5%-47.3%) for the vaginal compared with 6.8% (95% CI, 1.9%-11.7%) for the abdominal technique (P < 0.001). The relative risk that the abdominal technique results in bladder injury compared with the original transvaginal was 0.18 (95% CI, 0.08-0.38).
  
  
  CONCLUSIONS
  Bladder perforation occurs significantly less frequently with abdominal needle placement for the TVT procedure. We recommend this technique to less experienced surgeons.
authors.affiliation: Department of Obstetrics, Gynecology, and Women's Health, St Louis University School of Medicine, St Louis, MO, USA. mclennan@slu.edu
authors.forename: Mary T
authors.initials: MT
authors.lastname: McLennan
authors.forename: Susan A
authors.initials: SA
authors.lastname: Barr
authors.forename: Clifford F
authors.initials: CF
authors.lastname: Melick
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gavard
mesh_terms: D002983:Clinical Competence; D053715:Cystotomy; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D053825:Suburethral Slings; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000293:injuries*; D014550:Urinary Incontinence, Stress / Q000601:surgery*