[Use of "TVT" in surgery for female urinary incontinence]

The TVT procedure (tension-free vaginal tape) was described by U. Ulmsten (Sweden) in 1996. This new procedures questions the numerous procedures proposed for female stress urinary incontinence (SUI). The mesh is placed under the urethra (and not under the bladder neck) and cures SUI without important voiding difficulties. Use of this operation is growing fast in Europe and Australia and is beginning to be used in the USA. TTV is a minimally invasive technique using local or spinal anesthesia applicable as an ambulatory procedure. Peroperative complications are limited to bladder perforation (without detrimental consequences) and bleeding. Postoperative complications are very rare. Local tolerance of the prolene mesh is excellent. Failure rates have been very low, about 6% for SUI and more controversial for unstable bladder. Since January 1997, we have performed about 400 TVT either as single procedures or in association with prolapsus cure. After 1 to 3 years follow-up, cure rate in the first 156 SUI patients was 89.1%, almost the same with or without associated procedures. For the 36 patients with an urethral closure pressure less than 30 cm H(2)O, cure rate was 75%. In cases of mixed incontinence, the cure rate varied from 57.9% (associated procedures to 61.3% (single procedures). The rate of de novo instability was less than 4.6%. Induced and increased voiding difficulties (5.7% and 6% respectively) remained at a relatively low level provided the strict operative protocol was used. The TVT procedure is easy to perform, relatively harmless, reproducible and very efficient even for patients with risk factors, sphincteric weakness, previous operations or an associated prolapsus cure procedure.