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Effects of a modified technique for TVT-O positioning on postoperative pain: single-blind randomized study

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Abstract

Introduction and hypothesis

One of the most frequent and distressing complications of the tension-free vaginal tape obturator (TVT-O) procedure for stress urinary incontinence (SUI) is groin pain, which may be related to the surgical technique or to the tape. The aim of this study was to evaluate the impact of a more limited dissection and a more medial trocar trajectory in TVT-O positioning on postoperative pain.

Methods

Seventy-two SUI patients were randomized to undergo TVT-O either with the traditional technique (group A) or a modified procedure (reduced paraurethral dissection and a more medial trocar trajectory) (group B). Visual analog scale pain scores 12 h, 24 h, and 1 month after the procedure, number of analgesic vials, objective cure rate, and patient functional and quality of life scores 6 months after the procedure were evaluated. Data were analyzed by the Student’s t test for parametric variables, the Mann–Whitney U and Wilcoxon tests for nonparametric variables, and Fisher’s exact test for categorical variables.

Results

Pain scores were significantly lower in group B compared with group A 24 h after surgery (P = 0.01). Pain scores significantly decreased from 12–24 h postoperatively to 1 month follow-up in both groups (P < 0.001). No significant differences were observed in the number of analgesic vials administered, cure rates, and questionnaire scores between the two groups.

Conclusions

More limited dissection and a more medial trocar trajectory of TVT-O seem to reduce postoperative groin pain at 24 h after the procedure, but not the analgesic requirement.

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Conflicts of interest

Giovanni A. Tommaselli and Carmine Nappi accepted paid expenses from Gynecare; all other authors state that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy

    Giovanni A. Tommaselli, Carmen Formisano, Costantino Di Carlo, Annamaria Fabozzi & Carmine Nappi

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  1. Giovanni A. Tommaselli
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  2. Carmen Formisano
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  3. Costantino Di Carlo
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  4. Annamaria Fabozzi
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  5. Carmine Nappi
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Corresponding author

Correspondence to Giovanni A. Tommaselli.

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Tommaselli, G.A., Formisano, C., Di Carlo, C. et al. Effects of a modified technique for TVT-O positioning on postoperative pain: single-blind randomized study. Int Urogynecol J 23, 1293–1299 (2012). https://doi.org/10.1007/s00192-012-1758-3

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  • DOI: https://doi.org/10.1007/s00192-012-1758-3

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