[Treatment of urinary stress incontinence using suburethral implantation of tension-free vaginal tape (TVT). 4 years' experience].

OBJECTIVES: To analyze our results in terms of continence and complications of treatment of urinary incontinence with TVT during the 4 first years.

METHODS: 72 patients underwent surgery for urinary incontinence between 1999 and 2002. Chart review was performed for medical history, physical examination, urodynamic tests, surgical procedure, intraoperative and postoperative complications, objective and subjective results.

RESULTS: 62 patients were diagnosed of genuine stress urinary incontinence and 10 patients of mixed urinary incontinence. 14 patients had grade 3 cystocele, 12 of them underwent associated colporrhaphy. Operations were performed under local anaesthesia in 1 patient, spinal anaesthesia in 41 and general anaesthesia in 30. Mean operation time was 32 minutes, 66 minutes when colporrhaphy was associated, and previous surgery did not increase the surgical difficulty. 6 patients (8.3%) suffered bladder perforation which was identified during cystoscopy, but only required reposition of the tape without affecting patients' outcomes; 1 patient had a pelvic hematoma that evolved without sequel; 16 patients (22.22%) had urinary retention which spontaneously resolved between 2 and 60 days, except one case that required section of the mesh. 8 patients (11.11%) developed de novo bladder instability; there were 2 cases of late mesh perforation into urethra or bladder, which were solved by endoscopic mesh section; 3 patients had voiding discomfort and 1 chronic perineum pain. 70 patients (97.3%) achieved continence under stress; nevertheless only 57 patients (79.17%) were satisfied with their outcomes. Main causes for dissatisfaction were failure, de novo instability, persistence of urgency in cases of mixed incontinence, and voiding discomfort. Previous surgery and performance of associated procedures did not influence outcomes, although they were associated with longer operation times and higher incidence of urinary retention. Patients with Valsalva's leak point pressure < 60 H2O cm had slightly worse outcomes (63.5% satisfaction).

CONCLUSIONS: TVT is an easy to learn and easy to perform technique, with few complications and good results.