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Lateral Excision of Tension-Free Vaginal Tape for the Treatment of Iatrogenic Urethral Obstruction

Cheng-Yu Long, MD^*, Tsia-Shu Lo, MD, Cheng-Min Liu, MD^*, Shih-Cheng Hsu, MD^*, Yu Chang, MD^* and Eing-Mei Tsai, MD, PhD^*

From the *Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; and Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University, Tao-Ysuan Hsien, Taiwan

Address reprint requests to: Dr. Eing-Mei Tsai, Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao Kang Hospital, 482 Shan-Ming Road, Hsiao-Kang Dist. 812, Kaohsiung, Taiwan; e-mail: K83263{at}kmhk.kmu.edu.tw.

OBJECTIVE: To report our experience on lateral excision of tape in women with iatrogenic urethral obstruction after the tension-free vaginal tape (TVT) procedure.

METHODS: Seven women had iatrogenic urethral obstruction based on their clinical and urodynamic findings. All underwent lateral excision of the tape using the vaginal approach. Lower urinary tract symptoms, postvoid residual volume and urodynamic data were evaluated before and after excision.

RESULTS: Before excision, all subjects had either irritative symptoms or increased postvoid residual volume (more than 100 mL), and 6 (85.7%) voided with strain. The mean time from initial surgery to tape excision was 28 days (range 4 to 108), with an average follow-up of 32 months (range 24–39). After the excision, voiding dysfunction was resolved in 6 of 7 patients. The remaining patient had significant improvement with only occasional symptoms of irritation. Two (28.6%) women reported recurrent stress incontinence and 1 (14.3%) required surgical treatment. The intervals for the 2 recurrent patients from TVT to excision were 4 days. The intervals for the 5 continent women were 15 to 108 days.

CONCLUSION: Urethral obstruction after TVT is a relatively uncommon condition. It can be effectively treated with transvaginal lateral excision of the tape. Recurrent stress incontinence seems to be less likely to occur when the takedown procedure occurs beyond 14 days after the initial TVT operation.

LEVEL OF EVIDENCE: III

This article has been cited by other articles:

				C. Y. Long and E. M. Tsai Lateral Excision of Tension-Free Vaginal Tape for the Treatment of Iatrogenic Urethral Obstruction Obstet. Gynecol., June 1, 2005; 105(6): 1491 - 1492. [Full Text] [PDF]

				H. Phillip and P. Tooz-Hobson Lateral Excision of Tension-Free Vaginal Tape for the Treatment of Iatrogenic Urethral Obstruction Obstet. Gynecol., June 1, 2005; 105(6): 1490 - 1491. [Full Text] [PDF]