There have been, over the last two to three years, a spate of articles in various journals about the tension-free vaginal tape operation. The authors claim that the tension-free vaginal tape is an effective treatment for all women requiring surgery for genuine stress incontinence and that it may even be effective in women with mixed incontinence1.
In this paper, two surgeons operated on 161 women and they claimed a 94% cure rate at 16 (7) [mean (SD)] months. The level of expertise of the two surgeons was not mentioned, nor was their success rate with tension-free vaginal tape measured against their success with the tried and tested Burch colposuspension.
Most studies of the tension-free vaginal tape operation are of 13–18 women. By contrast, 344 women were recruited into a multicentre, prospective, randomised trial of colposuspension compared with the tension-free vaginal tape operation for primary genuine stress incontinence in the UK, and the results at six months were presented at the meeting of the International Continence Society in August 2000 in Tampere, Finland2. These early results showed that the success of both colposuspension and the tension-free vaginal tape operation varied widely between institutions. No reason for this was stated but it was possibly related to the skill of the surgeons.
There is also a question of consent. Nilsson and Kuuva1 state that they obtained ‘informed consent’ but did not elaborate on this. There are few long term results with the tension-free vaginal tape operation, and we wonder whether the women were informed of the authors' inability to counsel them adequately regarding long term effects and complications. Another paper presented at the International Continence Society meeting in Finland3 drew the conclusion that there is a definite ‘learning curve’ with the tension-free vaginal tape operation and that the operation should only be performed by experienced urogynaecologists. As we do not know the surgeons' level of skill in this study, we are uncertain about their rates of cure and complications in the long term.
We are therefore anxious that articles written by urologists and urogynaecologists with an interest in the treatment of incontinence portray the tension-free vaginal tape operation as easy. This may encourage generalists who have never performed a sling operation or needle suspension and who may have little experience of cystoscopy to attempt the tension-free vaginal tape operation. One of us (N.N.) has been on a ‘training course’ to learn the techniques of the tension-free vaginal tape operation and has a certificate to prove it. This training course is inadequate. The instructors assumed that we had all used a cystoscope, but this was not the case.
We believe that the tension-free vaginal tape operation is easy only for surgeons who have a special interest in female urinary incontinence. Women must be made aware that this is a new procedure and although technically simple in experienced hands, the long term results and complications are as yet unknown.