Double Tension Adjustments with Novel Modification on Tension-Free Vaginal Tape

Objective: To evaluate the results of novel modifications on tension-free vaginal tape (TVT) for the treatment of women with stress urinary incontinence (SUI). Materials and Methods: Sixteen female patients (average age 49.29 years, range: 31-78) who underwent anti-incontinence surgery to correct their SUI in the period between June 2010 and August 2014 were included in the study. In situ anterior vaginal wall sling was prepared, and monofilament polypropylene tape passed below the in situ-sling and standard TVT procedure was performed. Both ends of the mesh in the suprapubic region were labeled with Vicryl sutures and left outside the wound. The middle of the mesh in the vaginal region were labeled with similar suture and left outside the vagina. Foley catheter was removed on the third postoperative day. The average period of follow-up was 8 months (range: 5-17). Results: All patients benefited from the surgery; 15 (94%) of them completely cured and one patient clinically improved. Urinary retention was observed in one patient where the tension of the tape was reduced using adjustment sutures. No vaginal mesh erosion was detected during the gynecological examination postoperatively. No significant post-voiding residue was detected after catheter removal. Conclusion: This technique gives feasible option to adjust the tension of the mesh in the early post-operative period in case of urinary retention. Presence of intervening in situ sling reduces the risk of vaginal erosions. Long-term success is expected because dislocation of the mid-urethral sling is less likely.