Tension-free vaginal tape (TVT) procedure.

OBJECTIVE

To provide an introduction to the tension-free vaginal tape(TVT) procedure, placing it in the context of minimally invasive surgeries for the treatment of urinary stress incontinence in women, and to provide guidance to surgeons counseling women on the merits of this surgical choice.

OPTIONS: This discussion is limited to surgical treatment of urinary stress incontinence in women.

EVIDENCE: A search of both MEDLINE and the Cochrane Library identified the most relevant medical evidence. This document represents an abstraction of the evidence rather than a methodological review.

VALUES: This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada (SOGC).

BENEFITS, HARMS, AND COSTS: Counseling for the surgical treatment of urinary incontinence should consider the harms-benefits ratios of various options and include a measure of the"weight" of the evidence.

RECOMMENDATIONS: 1. The Burch procedure should be offered as the gold standard. The TVT procedure is promising but currently under evaluation in trials that will establish its efficacy and safety (II-3A). 2. Proper training is recommended prior to performing TVT procedures. 3. Long-term trial results are needed before the TVT procedure can be offered to patients as an equal alternative to the Burch procedure.

VALIDATION: This technical update has been approved by the Sub-Committee on Urogynaecology and Executive and Council of the SOGC.