7.6: 7.6-The Retropubic TVT (TVT-R)

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The classic retropubic tension – free vaginal tape (TVT-R) is a safe and well – tolerated procedure with an 81% cure at 7 years follow – up, and an improvement rate of 94%. Some fatalities have occurred due to bowel damage and uncontrolled retropubic haemorrhage. A few small, retrospective, non – randomized studies comparing retropubic to the newer transobturator procedures show similar cure rates, but these studies are too underpowered to show meaningful differences in complications rates. Review papers suggest the obvious, that obturator approaches are safer because of avoidance of pelvic cavity viscera – but no hard evidence exists to support this notion. Given that transobturator approaches are probably safer and equally as effective as retropubic TVT, the thoughtful continence practitioner must consider if the “inside – out” route is safer, or otherwise, than the “outside – in” transobturator approach.