Laparoscopic surgical complete sling resection for tension-free vaginal tape-related complications refractory to first-line conservative management: a single-centre experience.

BACKGROUND Tension-free vaginal tape (TVT) has been largely used for the management of stress urinary incontinence. In certain cases, however, this procedure results in bothersome complications that lead to a complete resection. OBJECTIVE We assessed the technical feasibility and functional outcome after complete laparoscopic resection of TVT. DESIGN, SETTING, AND PARTICIPANTS Thirty-eight women with TVT-related complications refractory to first-line management underwent a complete laparoscopic tape resection between 2001 and 2009. SURGICAL PROCEDURE Complete laparoscopic resection was achieved with either an intra- or extraperitoneal laparoscopic approach. Laparoscopy was performed with four ports: a 10-mm umbilical telescope port, two 5-mm ports placed medially to the anterior superior iliac spines, and a 10-mm port placed at the midpoint between the pubis and umbilicus. The two half-tapes were dissected towards the urethra and removed. MEASUREMENTS All data referring to patient demographics, surgery, tape-related complication, and perioperative outcomes were recorded. RESULTS AND LIMITATIONS The mean age of the patients was 66.2 yr (range: 45-79 yr). TVT-related complications included bladder erosion, vaginal extrusion, and bladder outlet obstruction or groin pain. The resection took place at a mean time of 25 mo (range: 6-80 mo) after TVT placement. Resection was complete in all patients, within a mean operative time of 110 min (range: 50-240 min). All women reported a total decrease of symptom-related complications within a mean follow-up period of 37.9 mo (range: 2-80 mo). However, recurrent incontinence occurred in 65.7% (n=25) of the patients. The main limitation of the study was the lack of a validated questionnaire to assess the evolution of functional disorders. CONCLUSIONS Complete laparoscopic resection of TVT is safe and technically feasible. In the limited number of women who have persisting disabling symptoms after conservative management, urologists must be aware that a complete resection can help resolve the symptoms.