Persistent urinary retention tied to TVT use

OB/GYN News, Nov 15, 2001 by Kathryn DeMott

Strict adherence to protocols for inserting tension-free vaginal tape should be closely followed, according to the authors of the first report of a case of transurethral penetration of the tape.

In the report, Dr. Heinz Koelbl and his associates at Martin-Luther University, Halle-Wittenberg, Germany, described a 45-year-old woman who developed persistent urinary retention that wasn't relieved even after the tension-free vaginal tape (TVT) was cut.

A bladder stone was diagnosed and removed. One year after her primary surgery the patient reported intolerable urgency dysuria, nocturia, and pelvic pain.

Urethrocystoscopy showed the tape penetrating through the urethra, but due to excessive fibrosis of the surrounding tissue, removal of the tape required an extensive and complex excision procedure (Br. J. Obstet. Gynaecol. 108[7]:763-65, 2001).

The authors concluded that "voiding disorders following insertion of the tension-free vaginal tape must not be underestimated."

Cutting the tape suburethrally in the midline can help overcome urinary retention. But if retention persists with large residual volumes, "this might be the first sign of transurethral penetration of the tape," they said.

Bladder stones could be the result of a foreign body reaction to the tape in the lower urinary tract, they added.

For such complications to be avoided, "it is important to emphasize that the tape is only loosely placed under the middle part of the urethra and that no elevation is allowed," the investigators stressed.