Laparoscopic surgical complete sling resection for tension-free vaginal tape-related complications refractory to first-line conservative management: a single-centre experience

Abstract

Background: Tension-free vaginal tape (TVT) has been largely used for the management of stress urinary incontinence. In certain cases, however, this procedure results in bothersome complications that lead to a complete resection.

Objective: We assessed the technical feasibility and functional outcome after complete laparoscopic resection of TVT.

Design, setting, and participants: Thirty-eight women with TVT-related complications refractory to first-line management underwent a complete laparoscopic tape resection between 2001 and 2009.

Surgical procedure: Complete laparoscopic resection was achieved with either an intra- or extraperitoneal laparoscopic approach. Laparoscopy was performed with four ports: a 10-mm umbilical telescope port, two 5-mm ports placed medially to the anterior superior iliac spines, and a 10-mm port placed at the midpoint between the pubis and umbilicus. The two half-tapes were dissected towards the urethra and removed.

Measurements: All data referring to patient demographics, surgery, tape-related complication, and perioperative outcomes were recorded.

Results and limitations: The mean age of the patients was 66.2 yr (range: 45-79 yr). TVT-related complications included bladder erosion, vaginal extrusion, and bladder outlet obstruction or groin pain. The resection took place at a mean time of 25 mo (range: 6-80 mo) after TVT placement. Resection was complete in all patients, within a mean operative time of 110 min (range: 50-240 min). All women reported a total decrease of symptom-related complications within a mean follow-up period of 37.9 mo (range: 2-80 mo). However, recurrent incontinence occurred in 65.7% (n=25) of the patients. The main limitation of the study was the lack of a validated questionnaire to assess the evolution of functional disorders.

Conclusions: Complete laparoscopic resection of TVT is safe and technically feasible. In the limited number of women who have persisting disabling symptoms after conservative management, urologists must be aware that a complete resection can help resolve the symptoms.