How Important Is TVT Location?

This study involved 136 women who underwent successful tension-free vaginal tape (TVT) placement for treatment of urodynamic stress incontinence. Postoperative evaluations ranged from 5 weeks to 2 years after surgery and included clinical examination with independent flowmetry, translabial ultrasound for residual urine and tape position and mobility, and a standardized questionnaire for evaluation of symptoms of incontinence. Translabial ultrasound identified the position of the superior tape margin relative to the inferoposterior symphyseal margin and the bladder neck both at rest and on Valsalva. Craniocaudal tape mobility, dorsoventral tape mobility, and total tape mobility were calculated. The patients ranged in age from 20 to 83 years of age at the time of surgery (average, 54.7 years). Postoperative urinary symptoms reported by patients included stress incontinence (12%), urinary incontinence (46%), frequency (13%), nocturia (21%), and voiding dysfunction (hesitancy, poor stream, stop-start voiding, or straining to void) (69%). At rest, ultrasound images showed the tape at positions ranging from 30 mm above to 12.7 mm below the symphysis pubis. On Valsalva, the tape was between 15 mm and 18.7 mm below the symphysis. The distance between the caudal and the bladder neck ranged from 0.3 to 3.3 mm at rest. No significant associations were seen between tape position or mobility and urinary symptoms. However, stress incontinence was somewhat more likely in women with greater horizontal distances from the tape to the symphysis pubis (P = 0.048), and urge incontinence, frequency, and voiding dysfunction were somewhat more likely with a more cranial tape on Valsalva (P = 0.03, 0.048 and 0.029, respectively). Patient reports of subjective cure and satisfaction had no association with tape position or mobility.