PubMed · 2041143
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G W Leadbetter, J Y Gillenwater. 1991-06-19. Urology.. https://pubmed.ncbi.nlm.nih.gov/2041143/
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As use of the tension-free vaginal tape (TVT) grows, more unexpected findings during this procedure are likely to be encountered. However, concomitant resection of a bladder tumor during the TVT procedure is rare. A TVT operation was carried out in a 56-year-old woman with urodynamic stress incontinence. A bladder tumor located in the trigone was found incidentally during cystoscopy. Concomitant resection of the bladder tumor was performed following the TVT procedure. The surgical result of our patient suggests that concomitant resection of a benign intravesical pathology with TVT procedure is safe and effective. Moreover, it does not compromise overall improvement of stress incontinence. The value of cystoscopy during the TVT procedure is emphasized.
Because of the bladder injuries risk and subsequent increase of the intervention time due to the bladder integrity checking, many surgeons have abandoned TVT. Based on a demonstrative clinical case, we report a simple, fast and effective method meant to minimize the risk of bladder injuries and to wonder about the mandatory bladder checking by cystoscopy during the TVT sling installation. An infiltration of 1% Xylocaïne half diluted is carried out in the area laterally to the urethra and the bladder, through vaginal and pubic ways. A 360 ml blue of methylene solution bladder filling may show quickly and safely a bladder injuries occurrence, either a true transfixion or an under mucous route. Using this procedure, TVT technique could be no more dangerous or longer than the TOT technique.
Recurrent urinary tract infections and symptoms of a hyperactive bladder in women having undergone a TVT (tension-free vaginal tape) procedure may be due to intravesical position of the tape. Urogenital ultrasound can provide early preliminary diagnostic evidence, which can then be confirmed by subsequent urethrocystoscopy. Minimally invasive revision can be achieved by transurethral resection of the intravesical TVT portions. Tape portions near the wall can be removed after stretching of the tape with grasping forceps inserted through a suprapubically placed trocar. This simple procedure can spare the patient a more extensive repeat operation for removal of the intravesical TVT that may even require a combined abdominovaginal approach.