Effect of intraoperative ultrasonography on prevention of bladder injury during TVT procedure
Jimmy Nomura (1), Tokumasa Hayashi (1), Shino Tokiwa (1), Mika Nagae (1), Yugo Sawada (1)
(1) Kameda Medical Center, Kamogawa city, Japan
Mid-urethral sling such as tension-free vaginal tape (TVT) and transobturator tape (TOT) is the gold standard in the treatment of stress urinary incontinence (SUI) due to their efficacy safety and low invasiveness. Several lines of evidence have shown that TVT may be superior to TOT in in severe grades of SUI and with patients of intrinsic sphincter deficiency. However, TVT has shown to have higher risk of bladder injury compared to TOT. Since bladder perforation is the most common intraoperative complications during TVT procedure, it is important to prevent this complication. Hydrodissection of the retropubic space usually used to reduce bladder injury during TVT procedure. In the present study, we examined the effect of ultrasonography-guided hydrodissection in retropubic space on prevention of bladder injury during TVT procedure.
This retrospective cohort study was performed two hospitals (Hospital A: n=224, Hospital B: n=122) from January 2017 to December 2018. As a TVT sling, Advantege Fit (Boston Scientific) was used in all patients. In Hospital A, ultrasonography-guided hydrodissection was performed during TVT procedure, whereas normal hydrodissection without use of ultrasonography was performed in Hospital B. Hydrodissection is performed by injecting 40 ml of saline-adrenaline solution into retropubic space in both Hospital.
In Hospital A, intraoperative complications were no bladder injury, 2 vaginal injury (0.9%), and 1 hematoma (0.4%). In Hospital B, it was 4 bladder injury (3.2%), 1 vaginal injury (0.8%) and 2 hematoma (1.6%).
These results suggest that use of intraoperative ultrasonography may play a role in prevention bladder injury during TVT procedure.