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Complications of Mid-Urethral Tape Insertion
Abstract
Background: Urinary stress incontinence is a health condition affecting millions of women globally with an incidence reaching 35%. The initial management is usually of conservative nature in the form of pelvic floor muscle training. If this fails then surgical management is offered. There are different methods of managing urinary stress incontinence like mid-urethral tape (MUT) insertion, colposuspension or the use of urethral bulking agents. In our unit, MUT insertion has been the conventional method of surgical management.
Methods: The data were obtained from retrospective auditing of our practice in our Trust that was conducted on three different phases over 4 years (2011 to 2015). The source of information was the database and clinical notes.
Results: A total of 221 patients underwent MUT insertion. Thirty-five procedures were performed by urologists and 185 by gynecologists. Twenty-three surgeries were performed by gynecologic trainees under senior supervision. All the MUT insertions performed by urologists were performed by consultants. Fifty patients (22.6%) experienced urinary retention, 18 had to use clean intermittent catheterization (CISC) (8%), and 41 patients (13%) developed symptoms of over-active bladder. There have been four bladder perforations (1.8%) all associated with tension-free vaginal tape (TVT) procedures and two cases of tape erosions (1%). Four patients (5%) complained of groin pain post-operatively; all of them had undergone tension-free obturator tape (TVT-O) procedure. There have been no buttonhole injuries, pelvic hematomata, or bleeding complications. In addition to that there have been no post-operative infections.
Conclusions: Our complication rates have been concomitant with those described in literature. A surgical database proves helpful not only in auditing surgical effectiveness but also in comparing the surgical managements between different surgeons and departments.
J Clin Gynecol Obstet. 2019;8(2):44-47
doi: https://doi.org/10.14740/jcgo544
Methods: The data were obtained from retrospective auditing of our practice in our Trust that was conducted on three different phases over 4 years (2011 to 2015). The source of information was the database and clinical notes.
Results: A total of 221 patients underwent MUT insertion. Thirty-five procedures were performed by urologists and 185 by gynecologists. Twenty-three surgeries were performed by gynecologic trainees under senior supervision. All the MUT insertions performed by urologists were performed by consultants. Fifty patients (22.6%) experienced urinary retention, 18 had to use clean intermittent catheterization (CISC) (8%), and 41 patients (13%) developed symptoms of over-active bladder. There have been four bladder perforations (1.8%) all associated with tension-free vaginal tape (TVT) procedures and two cases of tape erosions (1%). Four patients (5%) complained of groin pain post-operatively; all of them had undergone tension-free obturator tape (TVT-O) procedure. There have been no buttonhole injuries, pelvic hematomata, or bleeding complications. In addition to that there have been no post-operative infections.
Conclusions: Our complication rates have been concomitant with those described in literature. A surgical database proves helpful not only in auditing surgical effectiveness but also in comparing the surgical managements between different surgeons and departments.
J Clin Gynecol Obstet. 2019;8(2):44-47
doi: https://doi.org/10.14740/jcgo544
Keywords
Mid-urethral tapes; Urinary stress incontinence; Complications