Tension free vaginal tape-transobturator route (TVT-O) is one of the most common and effective treatment of stress urinary incontinence worldwide. Voiding dysfunction is one of the recognized complications from all types of mid-urethral sling surgery. There were different methods described on management of voiding dysfunction. There was lack of standardized treatment and limited evidence showing which methods being the most appropriate.1 We have adopted the method of early mobilization and revision of tape tension. Yet, there were concerns of reducing the effectiveness of TVT-O. This study investigated the outcome of women receiving early tape revision due to voiding dysfunction after TVT-O surgery.

This is a retrospective analysis of a prospectively collected database of all the women undergoing TVT-O for urinary stress incontinence in a territory urogynaecology university hospital from 2010-2019. Their demographics data and pre-operative urinary symptoms results were collected in a standard consultation form. All women received an urodynamic study including uroflowmetry and pressure-flow cystometrogram before proceeding to TVT-O. TVT-O could be performed concomitantly with pelvic floor repair surgery. Operative records and post-operative symptoms were all collected. Voiding dysfunction such as incomplete bladder emptying, intermittent stream or straining to void, on the post-operative 1-3 days, if any, were reviewed and their operative records of revision of tape were reviewed. Subsequent urinary symptoms were documented. Outpatient follow-up were arranged firstly at 8 weeks, then one and two years after the surgery, to review their surgical outcome including the subjective outcome classified as “same, improved, or worse” were documented. Ethics approval was obtained. Statistical analysis was done by SPSS version 22.

A total of 680 women underwent TVT-O surgery. Twenty-four (3.5%) of them were found to have voiding dysfunction shortly after surgery and were managed by early tape mobilization. Their mean age was 63.0 ± 11.1 years, with median parity of 3.0 (1.3, 4.0) and mean body mass index 23.9±3.0 kg/m2. They underwent revision of tape tension at a median post-operative day 2.5 (2.0, 6.8), ranging from post-operative day 1 to 21 days. All the revisions were performed under local anaesthesia at bedside. The mean operative time or revision was 14.6 ± 5.5 minutes with mean estimated blood loss of 7.3±4.0 ml. Among them, 22 (91.7%) of them resumed normal voiding without significant retention of urine on the day or within 1-3 days after the revision. Two women required suprapubic catherization (SPC) for further bladder training. One SPC was performed on the day of tape tension revision and one was performed at 10 days after tape tension revision. Both of them can achieve normal voiding at 3 weeks after SPC insertion.
All of them attended the follow-up with a mean follow-up duration of 124.1 ± 108.7 weeks. Two (8.3%) complained of occasional minimal stress urinary incontinence. Due to mild symptoms, no medical or surgical treatment were required. There was no recurrence of stress urinary incontinence in others (91.7%). All of them were satisfied with the surgical outcome and graded outcome as “improved” after operation. Five (20.8%) women had urge urinary incontinence, with only one (4.2%) of them being de novo in nature after TVT-O. No medical nor surgical treatment were needed. There was no voiding difficulty or pain upon follow-up.

The chance of success of resuming normal voiding after early mobilization and revision of tape tension was similar to other studies1. This study showed that early mobilization and revision of tape tension can help to resume normal voiding for women suffering from voiding dysfunction after TVT-O while minimal recurrence of symptoms of stress urinary incontinence and presence of de novo urge urinary incontinence were found at intermediate term of follow-up. Longer follow-up would be helpful to review if any recurrence of urinary symptoms.

Early mobilization and revision of tape tension is an effective treatment option for women suffering from voiding dysfunction and early detection of voiding dysfunction post-operatively is required for early intervention.

Management of post-midurethral sling voiding dysfunction. International Urogynecological Assocation research and development committee opinion. Int Urogynecol J. 2018 Jan;29(1):23-28.