Transvaginal suture placement for bleeding control with the tension-free vaginal tape procedure.

Tension-free vaginal tape (TVT) is a well-established surgical procedure for the treatment of female urinary stress incontinence. The operation, described by Ulmsten in 1995, is based on a midurethral Prolene tape support. TVT is accepted as an easy-to-learn and safe minimally invasive surgical technique. Intraoperative bleeding was described as complicating former surgical methods for correction of female urinary stress incontinence as well as TVT. The aim of this paper was to describe a simple transvaginal hemostatic suture placement to control accidental intraoperative hemorrhage. Of 566 patients undergoing TVT and followed for up to 68 months, 9 (1.6%) had intraoperative bleeding of 200-800 ml, all of which were diagnosed and corrected among the first 466 procedures. The last 100 patients had a transvaginal hemostatic suture placed whenever more than minimal bleeding occurred and hemostasis was achieved immediately with all. The benefit of this minimal, fast, and simple surgical step is assessed and discussed.