title: Effects of a modified technique for TVT-O positioning on postoperative pain: single-blind randomized study.
abstract: OBJECTIVE
  One of the most frequent and distressing complications of the tension-free vaginal tape obturator (TVT-O) procedure for stress urinary incontinence (SUI) is groin pain, which may be related to the surgical technique or to the tape. The aim of this study was to evaluate the impact of a more limited dissection and a more medial trocar trajectory in TVT-O positioning on postoperative pain.
  
  
  METHODS
  Seventy-two SUI patients were randomized to undergo TVT-O either with the traditional technique (group A) or a modified procedure (reduced paraurethral dissection and a more medial trocar trajectory) (group B). Visual analog scale pain scores 12 h, 24 h, and 1 month after the procedure, number of analgesic vials, objective cure rate, and patient functional and quality of life scores 6 months after the procedure were evaluated. Data were analyzed by the Student's t test for parametric variables, the Mann-Whitney U and Wilcoxon tests for nonparametric variables, and Fisher's exact test for categorical variables.
  
  
  RESULTS
  Pain scores were significantly lower in group B compared with group A 24 h after surgery (P = 0.01). Pain scores significantly decreased from 12-24 h postoperatively to 1 month follow-up in both groups (P < 0.001). No significant differences were observed in the number of analgesic vials administered, cure rates, and questionnaire scores between the two groups.
  
  
  CONCLUSIONS
  More limited dissection and a more medial trocar trajectory of TVT-O seem to reduce postoperative groin pain at 24 h after the procedure, but not the analgesic requirement.
authors.affiliation: Department of Obstetrics and Gynecology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy. gtommaselli@yahoo.it
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Tommaselli
authors.forename: Carmen
authors.initials: C
authors.lastname: Formisano
authors.forename: Costantino
authors.initials: C
authors.lastname: Di Carlo
authors.forename: Annamaria
authors.initials: A
authors.lastname: Fabozzi
authors.forename: Carmine
authors.initials: C
authors.lastname: Nappi
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D017699:Pelvic Pain / Q000188:drug therapy / Q000209:etiology*; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods*; D011788:Quality of Life; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D053825:Suburethral Slings / Q000009:adverse effects*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery
chemical_list: D000700:Analgesics