A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure

Background To evaluate the therapy-associated morbidity of all patients who underwent a TVT operation in Finland by the end of the year 1999. Methods. Questionnaires on the number of operations and on the number of different complications were sent to 38 hospitals where TVT operations had been independently performed after an obligatory TVT training period. The primary TVT training center and a hospital, which did not use the standard TVT equipment, were excluded. Results. Among the 38 hospitals there were four university, 13 central and 21 local hospitals. The total number of operations was 1455. The incidence of bladder perforation was 38/1000, that of intra-operative blood loss over 200 ml 19/1000, of major vessel injury 0.7/1000, of nerve injury 0.7/1000, of vaginal hematoma 0.7/1000 and of urethral lesion 0.7/1000. The incidence of minor voiding difficulty was 76/1000, that of urinary tract infection 41/1000, of complete postoperative urinary retention 23/1000, of retropubic hematoma 19/1000, of wound infection 8/1000 and of vaginal defect healing 7/1000. No case of tape rejection or life threatening complication occurred and the incidence of complications requiring laparotomy was 3.4/1000. The ratio of number of complications to TVT operations performed did not vary significantly between different hospital types (p>0.05). Conclusion. The TVT procedure is a safe method for the treatment of stress urinary incontinence provided that appropriate training is offered.