Bladder filling test, cystoscopy, or both for checking bladder perforation in tension-free-vaginal tape operations
Is cystoscopy necessary in all TVT operations?
Keywords:Stress Urinary Incontinence, Tension-free-vaginal-tape, Bladder Perforation, Cystoscopy, Bladder Filling Test
Background/Aim: Tension-free-vaginal tape (TVT) has been widely used for treatment of stress urinary incontinence as a mid-urethral sling operation. Cystoscopy is routinely performed during tension-free-vaginal tape operations to check for bladder perforation or injury. This study aims to check the applicability and accuracy of the bladder filling test for predicting bladder perforation in tension-free-vaginal tape operations.
Methods: Between 2015 and 2020, 285 women who had TVT operations were subject to evaluation. Out of 285 cases, 23 cases were suspected subjectively by the operating surgeons to have visible or occult bladder perforation during the TVT procedure. A routine cystoscopy was performed at the end of all operations. Additionally, before the routine cystoscopy, in cases suspected of a visible or occult bladder perforation, the bladder was filled with 500 ml saline or diluted methylene blue dye through a urinary catheter (bladder filling test) to check for occult bladder perforation that might not be visualized by cystoscopy. Any fluid leakage through the paraurethral dissected canals or from the abdominal incisions was observed for the possibility of bladder perforation. The accuracy of the bladder filling test was compared to cystoscopy to diagnose bladder perforation in suspected cases. In addition, all cases were followed up for three months to record any cases with late or occult bladder perforations missed in the diagnosis using cystoscopy or the bladder filling test perioperatively.
Results: Out of 23 cases suspected subjectively by the operating surgeons to have visible or occult bladder perforation, 11 had visible bladder perforations (3.9%) confirmed by both cystoscopy and the bladder filling test. After the filling test, leakage at the abdominal incision site and/or para-urethral dissected canal was observed in all cases with bladder perforation. No leakage was observed in the remaining patients (n = 12) suspected of, but not diagnosed with bladder perforation by cystoscopy. The bladder filling test did confirm the same diagnosis revealed by cystoscopy in all suspected cases.
Conclusion: The bladder filling test was found to be very sensitive in predicting bladder perforation at tension-free-vaginal tape operations compared to cystoscopy. This test can decrease the need for routine cystoscopy at tension-free-vaginal tape insertion, and cystoscopy can be limited to cases with leakage in the bladder filling test.
Richter HE, Albo ME, Zyczynski HM, Kenton K, Norton PA, Sirls LT, et al. Urinary Incontinence Treatment Network. Retropubic versus transobturator midurethral slings for stress incontinence. The New England Journal of Medicine. 2010 Jun 3;362(22):2066-76.
Abrams P, Andersson KE, Apostolidis A, Birder L, Bliss D, Brubaker L, et al. Evaluation and Treatment of Urinary Incontinence, Pelvic Organ Prolapse and Faecal Incontinence. Neurourology and Urodynamics. 2018 Sep;37(7):2271-2. DOI: https://doi.org/10.1002/nau.23551
Nilsson CG, Palva K, Aarnio R, Morcos E, Falconer C. Seventeen years' follow-up of the tension-free vaginal tape procedure for female stress urinary incontinence. International Urogynecology Journal. 2013 Aug;24(8):1265-9. DOI: https://doi.org/10.1007/s00192-013-2090-2
Ulmsten U, Henriksson L, Johnson P, Varhos G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(2):81-6. DOI: https://doi.org/10.1007/BF01902378
Ulmsten U, Falconer C, Johnson P et al. A multicenter study of tension-free vaginal tape (TVT) for surgical treatment of stress urinary incontinence. International Urogynecology Journal and Pelvic Floor Dysfunction. 1998;9(4):210-3. DOI: https://doi.org/10.1007/BF01901606
Ford AA, Rogerson L, Cody JD, Aluko P, Ogah JA. Mid-urethral sling operations for stress urinary incontinence in women. Cochrane Database Systematic Review. 2017 Jul 31;7(7):CD006375. DOI: https://doi.org/10.1002/14651858.CD006375.pub4
Viereck V, Eberhard J. Surgical Treatment of Urinary Incontinence – Indications, Choice of the Surgical Approach, Surgical Technique, Treatment of Complications. Journal of Urology and Urogynaecology. 2008;15:37–42.
Abouassaly R, Steinberg JR, Lemieux M, Marois C, Gilchrist LI, Bourque JL, et al. Complications of tension-free vaginal tape surgery: a multi-institutional review. BJU International. 2004 Jul;94(1):110-3. DOI: https://doi.org/10.1111/j.1464-410X.2004.04910.x
Kuuva N, Nilsson CG. A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure. Acta Obstetricia et Gynecologica Scandinavica. 2002 Jan;81(1):72-7. DOI: https://doi.org/10.1034/j.1600-0412.2002.810113.x
Latthe PM, Foon R, Toozs-Hobson P. Transobturator and retropubic tape procedures in stress urinary incontinence: a systematic review and meta-analysis of effectiveness and complications. BJOG. 2007 May;114(5):522-31. DOI: https://doi.org/10.1111/j.1471-0528.2007.01268.x
Chung BS, Lee T, Kim JS, Lee HJ. Occult intraperitoneal bladder injury after a tension-free vaginal tape procedure. Yonsei Medical Journal. 2005 Dec 31;46(6):874-6.
Foley C, Patki P, Boustead G. Unrecognized BP with mid-urethral slings. BJU International. 2010 Nov;106(10):1514-8. DOI: https://doi.org/10.1111/j.1464-410X.2010.09378.x
Bschleipfer T, Oelke M, Rieken M. Diagnostic procedures and diagnostic strategy for lower urinary tract symptoms/benign prostatic hyperplasia: An overview. Der Urologe Ausg. A 2019 Mar;58(3):238-47. (In German).
Cetinel B, Demirkesen O, Tarcan T, Yalcin O, Kocak T, Senocak M, et al. Hidden female urinary incontinence in urology and obstetrics and gynecology outpatient clinics in Turkey: what are the determinants of bothersome urinary incontinence and help-seeking behavior? International Urogynecology Journal and Pelvic Floor Dysfunction. 2007 Jun;18(6):659-64. DOI: https://doi.org/10.1007/s00192-006-0223-6
Bianchi-Ferraro AM, Jarmy-Di Bella ZI, Castro RD, Bortolini MA, Sartori MG, Girao MJ. Single-incision sling compared with trans-obturator sling for treating stress urinary incontinence: a randomized controlled trial. International Urogynecology Journal. 2013 Sep;24(9):1459-65. DOI: https://doi.org/10.1007/s00192-012-1998-2
Walsh CA. TVT-Secur mini-sling for stress urinary incontinence: a review of outcomes at 12 months. BJU International. 2011 Sep;108(5):652-7. DOI: https://doi.org/10.1111/j.1464-410X.2011.10333.x
Andonian S, Chen T, St-Denis B, Corcos J. Randomized clinical trial comparing suprapubic arch sling (SPARC) and tension-free vaginal tape (TVT): one-year results. European Urology. 2005 Apr;47(4):537-41. DOI: https://doi.org/10.1016/j.eururo.2004.12.023
Fusco F, Abdel-Fattah M, Chapple CR, Creta M, La Falce S, Waltregny D, Novara G. Updated Systematic Review and Meta-analysis of the Comparative Data on Colposuspensions, Pubovaginal Slings, and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence. Eur Urol. 2017 Oct;72(4):567-91. DOI: https://doi.org/10.1016/j.eururo.2017.04.026
Abdel-Fattah M, Ramsay I, Pringle S. Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study. BJOG. 2006 Dec;113(12):1377-81. DOI: https://doi.org/10.1111/j.1471-0528.2006.01097.x
Deng DY, Rutman M, Raz S, Rodriguez LV. Presentation and management of major complications of mid-urethral slings: Are complications under-reported? Neurourology and Urodynamics. 2007;26(1):46-52. DOI: https://doi.org/10.1002/nau.20357
Cetinel B, Demirkesen O, Onal B, Akkus E, Alan C, Can G. Are there any factors predicting the cure and complication rates of tension-free vaginal tape? International Urogynecology Journal and Pelvic Floor Dysfunction. 2004 May-Jun;15(3):188-93. DOI: https://doi.org/10.1007/s00192-004-1141-0
Chung BS, Lee T, Kim JS, Lee HJ. Occult intraperitoneal bladder injury after a tension-free vaginal tape procedure. Yonsei Medical Journal 2005 Dec 31;46(6):874-6. DOI: https://doi.org/10.3349/ymj.2005.46.6.874
Abbas Shobeiri S, Garely AD, Chesson RR, Nolan TE. Recognition of occult bladder injury during the tension-free vaginal tape procedure. Obstetrics and Gynecology. 2002 Jun;99(6):1067-72. DOI: https://doi.org/10.1097/00006250-200206000-00021
Tanaka T, Kobayashi K, Hirose T. BP of the tension-free vaginal tape detected with a flexible cystoscope. Hinyokika Kiyo. Acta Urologica Japonica. 2006 Oct;52(10):805-6; discussion 807.
Buchsbaum GM, Moll C, Duecy EE. True occult BP during placement of tension-free vaginal tape. International Urogynecology Journal and Pelvic Floor Dysfunction. 2004 Nov-Dec;15(6):432-3. DOI: https://doi.org/10.1007/s00192-004-1181-5
Tseng LH, Lo TS, Wang AC, Liang CC, Soong YK. BP presenting as vulvar edema after the tension-free vaginal tape procedure: A case report. Journal of Reproductive Medicine. 2003 Oct;48(10):824-6.
Karateke A, Haliloglu B, Cam C, Sakalli M. Comparison of TVT and TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomised study. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Feb;49(1):99-105. DOI: https://doi.org/10.1111/j.1479-828X.2009.00957.x
Huang ZM, Xiao H, Ji ZG, Yan WG, Zhang YS. TVT versus TOT in the treatment of female stress urinary incontinence: a systematic review and meta-analysis. Therapeutics and Clinical Risk Management. 2018 Nov 20;14:2293-303. DOI: https://doi.org/10.2147/TCRM.S169014
Leone Roberti Maggiore U, Finazzi Agrò E, Soligo M, Li Marzi V, Digesu A, Serati M. Long-term outcomes of TOT and TVT procedures for the treatment of female stress urinary incontinence: a systematic review and meta-analysis. International Urogynecology Journal. 2017 Aug;28(8):1119-30. DOI: https://doi.org/10.1007/s00192-017-3275-x
- 97 168
How to Cite
Copyright (c) 2022 Uzeyir Kalkan, Murat Tuğrul Eren
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.