Abstract
Introduction and hypothesis
A concern when using the retropubic tension-free vaginal tape (TVT) for stress urinary incontinence (SUI) is bladder perforation. This article describes a technique hypothesised to reduce the risk of intra-operative bladder perforation, termed the large space of Retzius infiltration (LSORI) technique. A large volume of infiltration of 360 ml saline-vasoconstrictor solution (180 ml × 2) into the space of Retzius (LSORI) at the time of retropubic TVT insertion will reduce the incidence of intra-operative bladder perforations.
Methods
This was a retrospective study reviewing the medical records of 89 women who underwent the retropubic TVT procedure at two urogynaecology Units. The intra- and post-operative characteristics associated with minimal (MSORI) versus large retropubic space of Retzius infiltrations (LSORI) were examined.
Results
Eighty-nine patients undergoing SUI surgery met the inclusion criteria. Forty-one patients had MSORI (volume range 20–60 ml bilaterally) versus 48 who had the 180-ml bilateral LSORI. No bladder perforations (0%) occurred in the LSORI group versus four in the MSORI group (9.8%), found to be statistically significant (p = 0.013). All other outcomes examined had no statistical difference. The TVT-related pain incidence: 8.3% (LSORI) versus 9.8% (MSORI). Post-operative urinary retention incidence was 6.3% (LSORI) and 14.6% (MSORI). Retropubic haematoma incidence was 0% (LSORI) and 2.4% (MSORI). Post-operative UTI rate was 12.5% (LSORI) and 17.1% (MSORI).
Conclusions
This retrospective review revealed the potentially beneficial effect of the large (180 ml × 2) bilateral SORI with retropubic TVT placement in terms of the reduction in risk of bladder perforation. It also showed no potential added risk of post-operative complications.
Similar content being viewed by others
References
Nilsson C, Palva K, Aarnio R, Morcos E, Falconer C. Seventeen years follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. Int Urogynecol J. 2013;24:1265–9.
Schimpf MO, Rahn DD, Wheeler TL, Patel M, White AB, Orejuela FJ, et al. Sling surgery for stress urinary incontinence in women: a systematic review and metanalysis. Am J Obstet Gynecol. 2014;211(71):1–27.
Schierlitz L, Dwyer P, Rosamilia A, Murray C, Thomas E, De Souza A, et al. Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: A randomized controlled trial. Obstet and Gynecol. 2008;112:1253–1261.
Daneshgari F, Kong W, Swartz M. Complications of mid urethral slings: important outcomes for future clinical trials. J Urol. 2008;; 180:1890-1897.
Stav K, Dwyer P, Rosamilia A, Schierlitz L, Lim Y, Lee J. Risk factors for trocar injury to the bladder during mid urethral sling procedures. J Urol. 2009;182:174179.
Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J. 1996;7:81–6.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Electronic supplementary material
ESM 1
(MP4 224963 kb)
Rights and permissions
About this article
Cite this article
Ras, L., Roskam, S.F.N., Kruger, P.F. et al. Retrospective review of intra- and post-operative complications with minimal versus large space of Retzius infiltration at the time of retropubic TVT placement. Int Urogynecol J 30, 743–751 (2019). https://doi.org/10.1007/s00192-018-3730-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-018-3730-3