Tension-free vaginal tape operation: results of the Austrian registry

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Abstract

OBJECTIVE:

To assess the use of and perioperative complications associated with the tension-free vaginal tape operation with a central registry.

METHODS:

Fifty-five gynecology units completed questionnaires on patients undergoing the tension-free vaginal tape operation. Information was collected on patient, surgical, and postoperative data.

RESULTS:

A total of 2795 patients were entered. Overall, 773 patients (28%) had undergone previous surgery for incontinence or prolapse; 1640 (59%) tension-free vaginal tapes were performed as isolated operations, and 1155 (41%) were done in combination with other procedures. The median operating time for tension-free vaginal tapes alone was 30 minutes (range 10–120). Of the isolated tension-free vaginal tapes, 727 (44%) were performed with local, 711 (43%) with regional, and 193 (12%) with general anesthesia. In patients undergoing tension-free vaginal tape only, postoperative bladder drainage was obtained with intermittent catheterization in 389 (24%) patients, an indwelling urethral catheter in 1032 (63%), and a suprapubic catheter in 143 (9%). The bladder perforation rate was 2.7% overall (n = 75) and higher in patients with than in those without previous surgery (4.4% compared with 2.0%, P = .01). There were four bladder perforations (3.3%) among the 120 patients with previous colposuspension. Most patients undergoing tension-free vaginal tape only were able to void the next day (range 0 to over 64). A total of 68 patients (2.4%) required reoperation for reasons related to the tape (39 to loosen, remove, or cut the tape, or to place a suprapubic catheter, 19 for hematoma, one for bowel injury).

CONCLUSION:

The tension-free vaginal tape has become a frequently performed operation in Austria. There are considerable variations in clinical practice. The risk of bladder perforation was increased in patients with previous surgery. Severe complications were rare.

Section snippets

Materials and methods

All 95 departments of gynecology in Austria were contacted by mail about participating in the registry. A total of 55 units replied affirmatively and entered patients. The centers were asked to complete a single-page questionnaire for every patient undergoing a tension-free vaginal tape procedure. The questionnaire contained items regarding the patient (age, parity, previous gynecologic surgery), the operation (operating time, concomitant procedures, anesthesia, intraoperative complications,

Results

Fifty-five centers entered a total of 2795 patients. The median number of patients per center was 27 (range 4–239). Eight centers reported more than 100 patients. The median age of the patients was 60 years (range 28–93). Of these, 2022 (72%) had not undergone surgery for incontinence or pelvic organ prolapse (this included 531 patients who had undergone a simple hysterectomy only), whereas 773 had (Table 1). Overall, 1640 tension-free vaginal tape operations (59%) were done as isolated

Discussion

With 123 units sold in Austria in 1998, 2022 in 1999, and 3279 in 2000, the tension-free vaginal tape has rapidly become a widely performed operation in this country of 8 million people. According to the Ethicon company, more than 150,000 units have been sold worldwide. This advance has been unchecked by the lack of prospective randomized clinical trials comparing the new operation with established anti-incontinence operations such as abdominal colposuspension or suburethral slings. One

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Participating investigators and centers are as follows: P. Riss, I. Geiss, Krankenhaus Mödling; A. Staudach, M. Zajc, Landeskrankenanstalten Salzburg; G. Wagner, Krankenhaus der Barmherzigen Brüder, Vienna; R. Winter, A. Giuliani, K. Tamussino, University of Graz; S. Leodolter, E. Hanzal, O. Preyer, University of Vienna; C. Marth, D. Kölle, University of Innsbruck; R. Pavelka, Krankenhaus Oberwart; C. Gamper, O. Ungerböck, Krankenhaus Wiener Neustadt; L. Boubenizek, Krankenhaus der Barmherzigen Schwestern, Linz; P. Sevelda, Krankenhaus Lainz, Vienna; A. Beck, Hanusch Krankenhaus, Vienna; F. Marberger, Krankenhaus Kirchdorf an der Krems; R. Leikermoser, Krankenhaus der Elisabethinen, Linz; F. Girardi, Krankenhaus der Stadt Baden; F. Brandstetter, St. Josef Krankenhaus, Vienna; G. Trabitsch, D. Spiessberger, Krankenhaus der Schulschwestern St. Franziskus, Grieskirchen; W. Rösslhuber, Krankenhaus Oberndorf; K. Weghaupt, Krankenhaus Amstetten; G. Ralph, B. Baumgartner, Krankenhaus Bruck an der Mur; P. Wagenbichler, Ignaz Semmelweis-Frauenklinik, Vienna; R. Schmid, Krankenhaus Mistelbach; R. Burmucic, Krankenhaus Deutschlandsberg; M. Trockenbacher, Krankenhaus St. Johann in Tirol; P. Stumpner, Krankenhaus Rohrbach; F. Nagl, Krankenhaus Ried im Innkreis; G. Bartussek, Krankenhaus Wolfsberg; P. Klug, Krankenhaus Rottenmann; S. Bosak, Krankenhaus Lilienfeld; A. Bichler, Krankenhaus Bad Ischl; W. Gruber, F. Wierrani, Kaiser-Franz-Josef-Spital, Vienna; W. Grabensberger, Krankenhaus Judenburg; J. Burkl, Krankenhaus Waidhofen an der Thaya; M. Fabsits, Krankenhaus Oberpullendorf; P. Wurm, Krankenhaus Linz; H. Salzer, A. Mirna, A. Tammaa, Wilhelminen-Spital, Vienna; V. Schabus, Krankenhaus Spital an der Drau; T. Golaszewski, Krankenhaus Waidhofen an der Thaya; H. Enzelsberger, R. Heider, Krankenhaus Steyr; P. Lang, E. Gruber-Fröhlich, Krankenhaus der Barmherzigen Brüder, Graz; A. Breinl, Graz; A. Kerak, Krankenhaus Tulln; W. Grünberger, Krankenanstalt Rudolfsstiftung, Vienna; W. Neunteufel, Stadtspital Dornbirn; J. Klobasa, Waldviertlerklinikum Horn; A. Mayer, Krankenanstalt des Göttlichen Heilands, Vienna; H. Stopfer, Krankenhaus Klosterneuburg; S. Szalay, G. Mori, Krankenhaus Klagenfurt; H. Concin, Landeskrankenhaus Bregenz; B. Abendstein, J. Joost, Krankenhaus Hall/Tirol; I. Nürnberger, Landeskrankenhaus Leoben; E. Kermauner, Krankenhaus Hallein; P. Anderl, B. Mitterdorfer, Krankenhaus Lienz; W. Schneider, Krankenhaus Wels; M. Buczkowski, Krankenhaus Reutte; H. Pontasch, Krankenhaus Zell am See; all in Austria.

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