How important is TVT location?

Background: The tension-free vaginal tape (TVT) is claimed to be a midurethral procedure, but data on sling placement are scarce to date. The aim of this study was to investigate tape position and mobility and correlate this with postoperative symptoms of bladder dysfunction.

Methods: One hundred and forty-one women 5 weeks to 2.1 years (mean 0.66 years) after TVT placement took part in a prospective clinical observational study. Appointments consisted of standardized symptom questionnaire, clinical stress test flowmetry and translabial ultrasound. The main outcome measures were patient symptoms, subjective satisfaction and cure/improvement. Paired t-test and anova statistics were employed for continuous, normally distributed parameters.

Results: Tape position varied from 30 mm above to 12.7 mm below the symphysis at rest and between 15 mm above to 18.7 mm below the symphysis on Valsalva. The horizontal distance of the tape from the symphysis pubis was weakly associated with recurrent stress incontinence (p = 0.048). More cranial tapes were weakly associated with urge incontinence (p = 0.03), frequency (p = 0.048) and symptoms of voiding dysfunction (p = 0.029). There was no association between tape placement and patient satisfaction or subjective cure/improvement.

Conclusions: Position and mobility of the TVT vary markedly. This may be explained by varying degrees of dissection, localization of incisions and the preoperative degree of anterior vaginal wall prolapse. However, variations in placement seem to have relatively little effect on symptoms.