Tension-free Vaginal Tape (tvt) Revisited – Outcomes of Tvt and the Influence of Different Anaesthetic Approaches

Study design, materials and methods The study population consisted of 98 consecutive women who had TVT procedure in our Unit between May 2002 and February 2004. All patients had initial preoperative assessmentfull structured history, gynaecological examination, urinalysis, completion of symptoms/QoL questionnaire, a stress test in lying and standing positions with bladder volume of approx 300mls, one week voiding diary and residual urine measurements. They all had urodynamic evaluation preformed by medium fill dual channel subtracted cystometry with simultaneous pressure and flow voiding studies; those with previous/failed bladder neck surgery had videocystography. Postoperative evaluations were carried out at 3 and 6 months, and after 36 months postage-paid return envelope questionnaires with instructions were posted to the patients. The questionnaire was designed to obtain specific responses from the women with regard to their intraoperative and postoperative experiences, patient satisfaction or otherwise, any postoperative or ongoing adverse event or complications, with specific additional questions with visual analogue scale (VAS) to asses Quality of Life (QoL). Patient perceptions of changes in their symptoms and treatment outcome were measured with questions modified from our Unit urogynaecology questionnaire, and from the generic SF-36 and the disease specific Bristol female lower urinary tract symptoms questionnaire (1,2). Cure was defined as no postoperative stress urinary incontinence, both subjectively and objectively. The operations were performed as described previously (3), and were carried out under Local infiltration Anaesthesia + IV sedation (54 patients), General Anaesthesia (23 Patients), or Spinal/Epidural anaesthesia (9 patients). All patients received prophylactic antibiotics irrespective of anaesthesia type, and they all had post-void residuals less than 100mls, measured by bladder scan, before discharge from hospital. TVT was performed by/or under supervision of two experienced urogynaecologists. Data was entered into a database and analysed using SPSS 14.0.