Exxcellence pearls: voiding dysfunction after TVT Flashcards
Where is TVT typically placed?
How effective is it for relieving stress urinary incontinence?
Mid-urethral position exiting through retropubic space and abdominal wall or through the obturator foramina and exiting the groin.
80%
What are the complications of TVT?
What are the advantages and disadvantages of the trans-obturator approach?
Urinary tract injury (bladder perforation 2%), damage to surrounding tissues including bowel nerves or blood vessels, bleeding, infection, pain and voiding dysfunction.
Increased risk of groin pain but decreased risk of bowel or bladder injury or voiding dysfunction.
What is the rate of urinary retention and incomplete emptying after retropubic TVT?
What percentage experience urgency or urge incontinence with retropubic TVT?
47%
25%
What percentage of patients have urinary retention 4-6 weeks after TVT?
How is this managed?
1-2%
Surgical release of the sling transected beneath the urethra.
What can be done to decrease the risk of voiding dysfunction?
Sedation or regional anesthetic
How should patients be routinely managed after TVT?
What volume indicates an abnormal post void residual? How is this managed?
Voiding trial after anesthesia has worn off.
A post void residual of 100-150 mL by catheterization is abnormal.
Patients should be discharged with indwelling catheter or taught to self catheterize. Outpatient voiding trial should be performed every 3-4 days with the majority resolving within 14 days.
Another option is to use a Hegar dilator to apply downward pressure to the urethra or return to the OR to reposition the tape.
How does bladder erosion typically present?
Vaginal erosion?
Hematuria, recurrent urinary tract infection and/or urinary symptoms.
Pelvic pain, discharge, dyspareunia
How should urgency or urge incontinence that develops after TVT be managed?
Expectant management, behavioral and or pharmacologic management is appropriate initially. Most symptoms will resolve within 4-6 weeks. Persistent symptoms should be fully evaluated and treated for urge incontinence.
Which patients are not candidates for TVT?
Women who are pregnant or potentially may become pregnant. Patients with previous retropubic procedures may have significant scarring, making this blind procedure more risky due to distorted anatomy.
