The use of general anesthesia for the tension-free vaginal tape procedure and concomitant surgery

Background. To study the efficacy of performing the TVT procedure and concomitant surgery under general anesthesia in the management of urinary stress incontinent patients. Methods. Eighty-six women with genuine stress incontinence without pelvic relaxation syndrome were surgically managed. TVT procedures were performed using vigorous manual pressure against the abdominal wall to position and adjust the vaginal tape and ensuring no lifting of the urethra by intraoperative introital ultrasonography. Concurrent gynecologic procedures were performed, if indicated. The urodynamic studies, 1-h pad-tests and introital ultrasonography were performed preoperative and 1 year after surgery. Result. Six women were excluded for various reasons. Among 80 patients, 74 (92.5%) were cured, five improved and one failed. No major intra-or postoperative complications occurred. After surgery, urine leakage observed on the pad-tests was significantly reduced from a mean of 24 to 1.3 g. The operating time for the TVT procedure was 23 min, and postoperative hospital stay was 2.8 days. The position and mobility of the bladder neck showed no significant difference before and after surgery. De nova detrusor instability was observed in one patient. Spontaneous voiding with adequate volume of postvoid residual urine was noted for all patients by the fourth day postoperatively. Urodynamic parameters related to the voiding dysfunction showed no significant difference pre- and postoperatively. Conclusion. With modifications of the technique and the aid of intraoperative ultrasonography, the TVT procedure can be performed under general anesthesia. The procedure is safe, effective, minimally invasive, and has an additional benefit of correcting various coexisting gynecologic disorders in a single operation.