Urinary retention after tension-free vaginal tape procedure: Incidence andtreatment

Objectives. To review our experience with persistent urinary retention afte r the tension-free vaginal tape (TVT) procedure and report our treatment re sults. Ulmsten recently introduced the TVT procedure for female stress urin ary incontinence. Although the morbidity is minimal, no surgical procedure is without risks, and experience will better define the morbidity of the TV T procedure. Methods. Since November 1998, we have collectively performed 600 TVT proced ures. Of these, 17 patients (2.8%) developed urinary retention or symptoms consistent with obstruction (including hesitancy, straining to void, or fee ling of incomplete emptying) lasting more than 1 week from the date of the procedure. We reviewed the operative record, noting the operative time, est imated blood loss, presence of bladder penetration, and any reported compli cations. All 17 patients subsequently underwent transvaginal release on an outpatient basis. Results. Seventeen patients (mean age 56 years, range 38 to 81) underwent s ling release a mean of 64 days (range 6 to 228) after the TVT procedure. Al l patients voided to completion within 24 hours of release and reported no further subjective complaints of outlet obstruction. None of the subjects r eported de novo urge incontinence or urgency. In each patient, the estimate d blood loss was minimal; the operative time averaged 15 minutes. One ureth ral injury occurred and was managed intraoperatively without sequelae. Sixt een patients who underwent sling release have remained dry; the remaining p atient, in whom a urethral injury was repaired, redeveloped stress incontin ence and underwent an uncomplicated successful transvaginal sling procedure . Conclusions. Outlet obstruction is a risk of the TVT procedure and occurred with an incidence of 2.8% in our experience. The TVT mesh can be released by a simple vaginal incision under local anesthesia with rapid return to no rmal voiding. Although the number of patients studied was small, stress inc ontinence did not recur after uncomplicated release in our series. (C) 2001 , Elsevier Science Inc.