TVT and TOT - Indications and Complications

This is part of the Gynsurgery guidelines used in an educational setting for residents in Ob-Gyn.

Trans Vaginal Tape (TVT) and Trans Obturator Tape (TOT) Procedure

 * 1) Stress urinary incontinence
 * 2) Cough or valsalva and observed leak of urine from urethra
 * 3) urethrovesical neck descensus–greater than 45 deg at rest or change of >= 30 degrees change with strain

Criteria for successful procedure

 * 1) Intrinsic sphincter deficiency has been ruled out if previous surgery, trauma, radiation near urethra
 * 2) Switch or discontinue medicines that affect internal urethral sphincter (alpha one blockers) if possible
 * 3) Switch medicines that affect external urethral sphincter (benzodiazepines, skeletal muscle relaxants) if possible
 * 4) Diagnose and treat any associated urge incontinence prior to surgery
 * 5) Diagnose and treat any associated excessive bladder capacity (>800 ccs) or excessive residual urine (>300ccs)  prior to surgery
 * 6) Rule out or treat any urinary tract infection prior to surgery
 * 7) Set reasonable post op expectations (decreased leakage, not absolutely dry)
 * 8) Teach diaphragmatic cough, lift and strain

Complications

 * 1) Continued bothersome incontinence
 * 2) New onset urinary urgency
 * 3) Obstructed voiding
 * 4) Ureter injury
 * 5) Bladder perforation or injury
 * 6) Urethral injury
 * 7) Bleeding/hematoma
 * 8) Mesh erosion
 * 9) Nerve injury
 * 10) Dyspareunia
 * 11) Suprapubic pain

Complication Prevention

 * 1) Continued bothersome incontinence
 * 2) New onset urinary urgency
 * 3) Obstructed voiding
 * 4) Ureter injury
 * 5) Bladder perforation or injury
 * 6) Urethral injury
 * 7) Bleeding/hematoma
 * 8) Mesh erosion
 * 9) Nerve injury
 * 10) Dyspareunia
 * 11) Suprapubic pain