The management of voiding dysfunction following mid urethral tape insertion

SummaryObjectiveNo standard regimen has been established for the management of postoperative voiding dysfunction following TVT insertion. This study was designed to compare two different strategies for management of this problem.MethodsThis is a retrospective study of women operated on within a tertiary referral unit.Two cohorts were identified: those managed by clean intermittent self catheterization (CISC) during 2006, and those managed by ‘pull-down’ of tape in the immediate post-operative period during 2007. Specific measurements include number of patients with resumption of normal voiding and time taken for resolution of symptoms. Incidence of tape division, recurrence of stress incontinence and development of overactive bladder (OAB) were also measured.ResultsThe incidence of voiding difficulty following TVT insertion remained the same in 2006 and in 2007. 45.5% of the CISC group resumed normal voiding compared to 100% of the ‘pull-down’ group. The incidence of tape division and reappearance of stress incontinence was 54.5% and 27% respectively in the CISC group compared to none in the ‘pull-down’ group. The CISC group also had higher incidence of OAB.ConclusionsImmediate “pull-down” of tape is an effective way of managing voiding dysfunction following TVT with an excellent rate of symptom resolution without any need of further intervention.