Combination of a tension-free vaginal tape procedure and laparoscopic-assisted vaginal hysterectomy for the treatment of benign uterine disease associated with stress urinary incontinence

Background: Women undergoing hysterectomy for benign uterine disease (BUD) may experience stress urinary incontinence (SUI). We performed tension-free vaginal tape (TVT) procedure and laparoscopic-assisted vaginal hysterectomy (LAVH) simultaneously and assessed the feasibility and efficacy of TVT performed under general anesthesia and the resultant anti-incontinence effects following the combined procedures. Methods: Between March, 2000 and March, 2002 inclusively, 63 patients, who suffered from both BUD and SUI, underwent LAVH and TVT. Preoperative evaluation included history-taking, physical examination and ultrasonography. One-hour pad test, multichannel urodynamics and urinary questionnaire were conducted preoperatively and postoperatively. Details about surgical procedures undertaken, hospitalization and urinary problems in the follow-up period were recorded. Results: 50 patients completed the study with a mean follow-up period of 34 (25-48) months. The mean age was 49 (39-67) years and mean parity 3 (2-6). The mean surgical duration was 163 (95-240) minutes and blood loss 284 (100-1,500) milliliters. Mean duration of hospital stay was 5.5 days and bladder drainage 1.9 days. Three patients suffered bladder perforation and one patient was complicated with excess blood loss. Postoperative urinary problems included transient urine retention, de novo frequency/urgency symptoms and voiding difficultly. Conclusions: The efficacy of concomitant TVT in LAVH procedure remained satisfactory in treatment of SUI associated with BUD. Both procedures reflect the benefits of less-invasive surgery. So the combination of LAVH and TVT is probably a good alternative for the patient who needs to undergo hysterectomy and anti-incontinence surgery simultaneously.