Title: long-term results of the tension-free vaginal tape (tvt) procedure for surgical treatment of female stress urinary incontinence.In a prospective long-term nordic multicenter study, 90 consecutive patients who had a tension-free vaginal tape (tvt) operation performed because of stress urinary incontinence were evaluated according to a strict protocol after approximately 5 years (range 4870 months).Eighty-five patients could be evaluated according to the protocol.Another 5 elderly patients had to be interviewed by telephone at the final check-up after 5 years.The study protocol involved pre- and postoperative objective and subjective evaluation.The median followup time was 56 months.All operations were performed under local infiltration anesthesia using 0.25% prilocaine with adrenaline (epinephrine).The tvt (ethicon) set consisted of two 6 mm needles connected to a handle (introducer) and a specific polypropylene prolene(ethicon) mesh tape fixed to the needles.Cystoscopy was performed twice during the operation, after each retropubic pass of the tvt needle(ethicon).Adjustment of the prolene tape the tension test was performed with the patient coughing repeatedly at a bladder volume of 250300 ml.A few drops of saline were allowed to escape the external meatus of the urethra in order to avoid postoperative retention.Reported complications included incontinence (n=2), surgery failed (n=4), hematoma (n=3), bladder perforation (n=1) ,intraoperative bleeding (n=3), post-operatvie voiding difficulties (n=4) ,urinary tract infection (n=7)-during the first months postoperatively ,infection (n=1), at long term follow-up visit a symptomatic urogenital prolapse grade i (n=2).Recurrent urinary tract infections (n=1), urge symptoms (n=25) and de novo urge symptoms (n=5) in conclusion the tension-free vaginal tape procedure seems to fulfil the expectations of high long-term follow-up cure rates that the short-term results have suggested.Including both subjective and objective criteria for cure or significant improvement, 95% of the tvt-operated women benefited significantly from the operation.The operation, performed under local anesthesia, was well tolerated and was associated with minimal short- and long-term postoperative morbidity.In the light of these good long-term results the tvt operation can be recommended as a routine surgical procedure for the effective treatment of female stress urinary incontinence.
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