Laparoscopic colposuspension for recurrent stress incontinence following failed tension-free vaginal tape (TVT) DESIGN: Technical video demonstrating laparoscopic colposuspension for previously surgically treated stress incontinence (Canadian Task force classification level III).
University Hospital.
58-year old woman with a previous TVT presents with recurrent stress urinary incontinence.
Mid-urethral slings (MUS) have equivalent cure rates to the more invasive colposuspension. They are preferentially used for stress urinary incontinence (SUI) despite a mesh erosion rate of 3.5% with 2.5% requiring further surgery, sling removal, or revision over 9 years. [1,2] Recent negative publicity concerning synthetic mesh tape has led to a resurgence of interest in mesh free alternatives, including urethral bulking agents, rectus fascia slings and colposuspension. Laparoscopic colposuspension is a well-established minimally-invasive surgery that avoids synthetic mesh, with a quicker recovery, less scarring, and equivalent success to an open approach. [3] Bladder neck mobility is an important marker during selection of this technique. In this video, we demonstrate our transperitoneal technique of colposuspension in the case of a failed TVT. This technique allows clear visualisation of the operating field and is faster and less bloody than a full dissection. As complications can ensue from extensive excision and extraction, unless the previous TVT has caused problems such as pain, we normally leave it in situ. Careful dissection is undertaken into Retzius space to the paravaginal tissues where the iliopectineal ligament is located. On each side, we apply two extracorporeally tied non-absorable Ethibond sutures as recommended [4], caudal and lateral to the TVT, lifting the paravaginal tissues to the ligament. The knot placed on the ligament side to minimise erosion risk. The peritoneal defect is closed with vicryl 2.0. This technique offers a viable mesh free option for treatment of recurrent stress incontinence in women who have had failed TVT.
Journal of minimally invasive gynecology. 2018 Jul 10 [Epub ahead of print]
Haider Jan, Vishalli Ghai, Ranee Thakar
Consultant Gynaecologist, Department of Obstetrics and Gynaecology, Epsom & St Helier's University Hospitals NHS Trust, Dorking Road, United Kingdom, KT18 7EG., Specialist Registrar, Department of Obstetrics and Gynaecology, Epsom & St Helier's University Hospitals NHS Trust, Dorking Road, United Kingdom, KT18 7EG. Electronic address: ., Consultant Urogynaecologist, Department of Urogynaecology, Croydon University Hospital NHS Trust, London Road, United Kingdom, CR7 7YE.