suture placement for bleeding control with the tension-free vaginal
Menahem Neuman Urogynecological Service, Department of
Gynecology, Shaare Zedek Medical Center, Ben-Gurion University of
the Negev, Jerusalem, Israel.
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.
Urogynecol J Pelvic Floor Dysfunct. 2006 Feb ;17 (2):176-7