Is Tension-free Vaginal Tape in the Correct Place? An Assessment by Postoperative Transperineal Ultrasonography at Three Months

Abstract

Objectives: To determine the position of tension-free vaginal tape (TVT) by transperineal ultrasound following placement by a standard blind insertion technique, and to investigate the relationship between position of TVT and associated clinical outcome.
Methods: Postoperative evaluation was conducted at 3 months with transperineal 2-dimensional ultrasound scan, standardised symptomatology questionnaire, visual analogue scale (VAS), and validated short form Incontinence Impact Questionnaire 7 in 32 women who had undergone TVT placement for genuine stress urinary incontinence.
Results: At 3-month examination, 90.6% of 32 women were subjectively cured. Tension-free vaginal tapes were placed within the target range of 50% to 70% of the urethral length in 65.6% of women. There was no difference in the urinary outcome between women with TVT placed within and outside the target range. Women with tape–
longitudinal smooth muscle (tape-LSM) distance of <3 mm or >5 mm had a significant improvement in VAS score (p=0.04) compared with those with tape-LSM distance of 3 to 5 mm. Nonetheless those with tape-LSM distance of <3 mm had voiding dysfunction (15.4% vs. 0%; p=0.08). Tape width reduced from an initially manufactured 11 mm to a mean width of 6.4 mm.
Conclusions: About one-third of TVTs were found by postoperative transperineal ultrasound to have been placed outside the target range using a standard blind insertion technique.