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Bladder perforation during tension-free vaginal tape procedures: abdominal versus vaginal approach
Mary T McLennan1, Susan A Barr, Clifford F Melick
1Department of Obstetrics, Gynecology, and Women's Health, St Louis University School of Medicine, St Louis, MO, USA. mclennan@slu.edu
Objective:
Bladder perforation rates for the tension-free vaginal tape (TVT) are higher with inexperienced surgeons. The purpose of this study was to examine if surgical approach affects this rate.
Methods:
We performed a retrospective cohort study of consecutive patients undergoing a TVT as the sole procedure. All cases were performed by senior residents using 2 different surgical approaches-vaginal or abdominal trocar passage. Power analysis indicated that 103 patients in each group (vaginal and abdominal approach) were required to demonstrate a 50% reduction in perforation rates.
Results:
The rate of perforation was 37.9% (95% confidence interval [CI], 28.5%-47.3%) for the vaginal compared with 6.8% (95% CI, 1.9%-11.7%) for the abdominal technique (P < 0.001). The relative risk that the abdominal technique results in bladder injury compared with the original transvaginal was 0.18 (95% CI, 0.08-0.38).
Conclusions:
Bladder perforation occurs significantly less frequently with abdominal needle placement for the TVT procedure. We recommend this technique to less experienced surgeons.
