Voiding dysfunction after the tension-free vaginal tape procedure

Throughout the past decade, pubovaginal slings have become the most widely used surgical procedure for the treatment of stress urinary incontinence. However, despite its widespread use and success rates, it is associated with a significant complication rate. In response to the high complication rate, the tension-free vaginal tape (TVT) was introduced. Based on the integral theory that stress urinary incontinence results from defective urethral support, the TVT consists of a loosely placed piece of prolene mesh under the urethra to recreate the pubourethral ligament. However, despite its tension-free nature, studies have shown that the TVT causes postoperative voiding dysfunction in 2.8% to 14% of patients. Radiologic and urodynamic studies suggest that postoperative voiding dysfunction is related to a change in outflow resistance during voiding, not to a change in the bladder neck positioning at rest. Although voiding dysfunction appears to be less after TVT than colposuspensions and the early pubovaginal slings, it does exist and patients should be warned of the potential complication.