Retrospective review of intra- and post-operative complications with minimal versus large space of Retzius infiltration at the time of retropubic TVT placement

Introduction and hypothesis: A concern when using the retropubic tension-free vaginal tape (TVT) for stress urinary incontinence (SUI) is bladder perforation. This article describes a technique hypothesised to reduce the risk of intra-operative bladder perforation, termed the large space of Retzius infiltration (LSORI) technique. A large volume of infiltration of 360 ml saline-vasoconstrictor solution (180 ml × 2) into the space of Retzius (LSORI) at the time of retropubic TVT insertion will reduce the incidence of intra-operative bladder perforations. Methods: This was a retrospective study reviewing the medical records of 89 women who underwent the retropubic TVT procedure at two urogynaecology Units. The intra- and post-operative characteristics associated with minimal (MSORI) versus large retropubic space of Retzius infiltrations (LSORI) were examined. Results: Eighty-nine patients undergoing SUI surgery met the inclusion criteria. Forty-one patients had MSORI (volume range 20–60 ml bilaterally) versus 48 who had the 180-ml bilateral LSORI. No bladder perforations (0%) occurred in the LSORI group versus four in the MSORI group (9.8%), found to be statistically significant (p = 0.013). All other outcomes examined had no statistical difference. The TVT-related pain incidence: 8.3% (LSORI) versus 9.8% (MSORI). Post-operative urinary retention incidence was 6.3% (LSORI) and 14.6% (MSORI). Retropubic haematoma incidence was 0% (LSORI) and 2.4% (MSORI). Post-operative UTI rate was 12.5% (LSORI) and 17.1% (MSORI). Conclusions: This retrospective review revealed the potentially beneficial effect of the large (180 ml × 2) bilateral SORI with retropubic TVT placement in terms of the reduction in risk of bladder perforation. It also showed no potential added risk of post-operative complications.