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Tension free vaginal tape: is the intra-operative cough test necessary?

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Abstract

The tension-free vaginal tape (TVT) procedure is recognised as an effective treatment for genuine stress incontinence. It was first described using local anaesthesia, with an intra-operative cough test helping to correctly position the tape. Many patients prefer general anaesthesia and often, patients with genuine stress incontinence do not leak when supine. This aim of this study was to compare the outcome in TVTs performed under general anaesthesia with those performed under spinal anaesthesia. Retrospective analysis of 105 patients, all of whom had urodynamically proven genuine stress incontinence and underwent TVT procedure, was performed: 52 under spinal anaesthesia and 53 under general anaesthesia. The primary and secondary outcome measures were the success or failure of the procedure and the complication rate, respectively. There was no significant difference in outcome or complication rate between the two groups. The type of anaesthetic used does not influence the outcome and we question the necessity of an intra-operative cough test.

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References

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Acknowledgements

We would like to thank Dr Y. Zubairi of the Department of Medical Statistics at the University of Reading for her advice.

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Correspondence to S. J. Low.

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Editorial Comment: Many surgeons in the USA perform the tension-free vaginal tape (TVT) either alone or with other pelvic reconstructive procedures under general anesthesia. The cough stress test as originally recommended under regional or local anesthesia is performed with the patient in the recumbent position, theoretically lessening its validity and reliability at predicting success. This small retrospective study demonstrates equal efficacy in short-term follow-up when TVT sling tensioning is performed by surgeon judgment as with other pubovaginal slings, or by using the cough stress test when feasible under spinal anesthesia. It is hoped that future studies with larger number of patients and longer follow-up will confirm this.

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Low, S.J., Smith, K.M. & Holt, E.M. Tension free vaginal tape: is the intra-operative cough test necessary?. Int Urogynecol J 15, 328–330 (2004). https://doi.org/10.1007/s00192-004-1176-2

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  • DOI: https://doi.org/10.1007/s00192-004-1176-2

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