A rare complication with TVT: vaginal protrusion of the tape

Urethrovaginal fistula—a rare complication after the placement of a suburethral sling (IVS)

A sixty-year-old woman with stress urinary incontinence had undergone a placement of an IVS (Tyco Health Care UK) in another hospital in February 2003. Seventeen months after the procedure, she complained about a suppurative discharge from the vagina and a recurrent severe stress urinary incontinence. The gynecological examination revealed an erosion of the sling into the vagina and a large urethrovaginal fistula bordered by granuloma. After removal of the sling, the urethrovaginal fistula was closed using a vaginal flap. A subsequent conservative treatment regime with duloxetine and pelvic floor training improved the stress urinary incontinence to the patient's satisfaction.

Prospective analysis of complications of tension-free vaginal tape from The Netherlands Tension-free Vaginal Tape study

OBJECTIVE

The intra- and postoperative anatomic complications, frequency, and influence of risk factors of the tension-free vaginal tape are described.

STUDY DESIGN

This was a prospective cohort study of 809 patients.

RESULTS

The total intraoperative complication rate was 6.2%. Previous prolapse surgery was a risk factor for complications (odds ratio, 2.86; 95% CI, 1.15-7.11). We found more intraoperative complications in patients with general anesthesia than with local analgesia with sedation (odds ratio, 4.14; 95% CI, 2.01-8.53). In teaching hospitals the postoperative complication frequency was higher than in non-teaching hospitals (odds ratio, 0.55; 95% CI, 0.35-0.85). The learning curve is short, and more postoperative complications were found in the second 10 patients who underwent operation by 1 surgeon (odds ratio, 1.94; 95% CI, 1.14- 3.29). Spinal analgesia gives fewer postoperative complications than local analgesia with sedation (odds ratio, 0.35; 95% CI, 0.13- 0.92).

CONCLUSION

Tension-free vaginal tape is a relative safe procedure; concomitant pelvic surgery can be performed safely. Several risk factors for complications were identified: menopausal state, previous prolapse surgery, mode of anesthesia, teaching hospital, and the second ten procedures of each surgeon.

Vaginal wall erosion after transobturator tape procedure

Transobturator Prolene tape insertion represents a new method of operative treatment for stress urinary incontinence. The first results show that it is a simple and effective procedure accompanied by a minimum number of complications. Since February 2004, 30 Monarc procedures were done at our department and no intraoperative complications were observed. However, two cases (6.7%) of vaginal wall erosion due to the Prolene tape were noted 6 weeks after surgery. In a subsequent surgical procedure, the periurethral portion of the tape was removed and a new Prolene tape was placed through the retropubic space. Three months after secondary surgery both patients were continent, with no sign of erosion. The transobturator approach was introduced to minimize the risk of complications. However, the greater prevalence of vaginal wall erosion after this procedure found in our series demands a scrupulous search for this complication and for the mechanisms leading to its occurrence.

Artificial graft slings at the midurethra: Physiology of continence

Surgeons have performed multiple variations of the pubovaginal sling procedure in an attempt to achieve reproducible results. In this review, the potential mechanisms by which midurethral slings restore continence are discussed. Surgical techniques are described and the results of recently published data in the literature are presented. Two midurethral slings, which employ loosely woven polypropylene mesh, are the tension-free vaginal tape (Ethicon Inc., Sommerville, NJ) procedure and the SPARC Sling System (American Medical Systems, Minneapolis, MN). They are used in this article to illustrate important clinical concepts.