Objectives: Data concerning the complications of TVT are rare, incomplete and discordant. We therefore decided to record all intraoperative and postoperative complications of TVT observed in our experience and to evaluate these complications as a function of the patients and operators.
Material and method: This was a single-centre retrospective study of 157 patients with a mean follow-up of 24 months (range: 5 to 50 months). We performed TVT either alone (76%) or associated with another pelvic surgical procedure (24%), especially simple vaginal hysterectomy (10%), and surgical repair of prolapse (14%). Some TVTs were performed in the presence of sphincter incompetence (32%) or mixed urinary incontinence (7%). The patient's history of pelvic surgery, vaginal surgery associated with TVT, the operator's experience, and the type of anaesthesia performed were assessed as risk factors for complications of TVT.
Results: The following complications were observed: bladder perforation (4.5%), urethral injury (0.6%), haemorrhagic dissection (5%), pelvic haematoma (0.6%), obturator nerve lesion (0.6%), suprapubic abscess (2%), urinary tract infection (7%), complete and lasting urinary retention (4%), expulsion of the TVT (2%), migration of the TVT (0.6%), de novo detrusor instability (1.5%). TVT was ineffective in 3% of patients.
Conclusion: Although a global TVT complication rate of 28.4% in our series may seem high, it should be noted that these complications have a limited morbidity and usually have no consequences. Bladder perforation, haemorrhagic dissection, and urinary retention are the complications most frequently reported (4% to 5%). In this series, a history of pelvic surgery, an associated vaginal surgical procedure, and the operator's experience did not constitute risk factors for complication except in the case of haemorrhagic dissections; a history of pelvic surgery appeared to be a risk factor for intraoperative bleeding. In our experience, it is difficult to evaluate whether or not the type of anaesthesia performed for TVT increases the complication rate.