Repair of Cystocele and Incontinence Using a Tension-free Vaginal Tape (TVT) Device

Bae, Jae Hyun; Lee, Jeong Gu

Abstract

PURPOSE: We report on a modified four-corner bladder neck suspension using a manufactured Tension-free Vaginal Tape (TVT) carrier for moderate-degree cystocele, with a simultaneous TVT procedure, for stress urinary incontinence (SUI).
MATERIALS AND METHODS
The operation was performed in 21 SUI patients with moderate cystocele. Seven patients were operated on under local anesthesia, and the others under general anesthesia. Two incisions were made over the suprapubic area, and a midline incision over the anterior vaginal wall for the TVT procedure. For cystocele repair, bilateral parallel incisions were made over both the lateral vaginal walls. Through the lateral incisions, a dissection was carried out to expose the vesicopelvic fascia. Then a Gore-Tex suture was placed on each side. Each suture incorporated the entire vaginal wall, excluding the epithelium, cardinal ligament and pubocervical fascia. We made two pinholes at the end of the TVT carrier for the suture materials to be threaded through. Using the TVT carrier, each thread was transferred to the ipsilateral suprapubic incisions through the retropubic space. Each side of the ligature was tied together under the subcutaneous space, and the TVT procedure completed.
RESULTS
Mean operation time and hospitalization days were 75+/-24 minutes and 3.3+/-2.19 days, respectively. The cystocele was fully corrected in 19 patients (90.5%), and diminished to grade I in 2. There were no significant operative or postoperative complications, including bladder perforations or retropubic hematomas, etc.
CONCLUSIONS
It is suggested that the repair of cystocele and incontinence, using a TVT device, is an effective treatment for moderated cystocele, with a simple technique, low morbidity and high cure rate.