Operation: Tension Free Vaginal Tape - Exact for Stress Urinary Incontinence

Date: _______________
Surgeon: _______________
Assistant(s): _______________
Anesthesia: general anethesia
PreOp Dx:

1. Stress urinary incontinence
2. Grade 2 prolapse

PostOp Dx:

1. Same

Procedure: Tension Free Vaginal Tape
Estimated Blood Loss: 150 cc
Complications: None
Findings:

1. As above, grade 2 prolapse noted.
2. Normal cystoscopy, ureteric jets visualized bilaterally

Disposition: The patient was transfered to PACU in stable condition and will follow a standard bladder protocol prior to discharge.
Clinical Note: Ms. _______________ is a 56 year-old female G3P3 known to have progressing stress urinary incontinence. Urodynamic studies confirmed this diagnosis and the options of management, including expectant, medical, and surgical management, were discussed in the clinic. She had elected for surgical management with TVT and the risks, benefits, and alternatives were reviewed prior to her signing of consent.

Procedure Note: Ms. _______________ was taken to the operating room and under general anaesthetic in the dorsal lithotomy position, the patient was prepped and draped in the usual manner. The bladder was emptied with an in and out catheter and a weighted speculum inserted. Two allis clamps were placed along the anterior vaginal wall beginning 1 cm below the urethra and 3cm apart vertically. A 2cm incision was made between the Allis clamps and the anterior vaginal mucosa. The periurethral tissue was dissected with the Metsenbaum scissors and blunt dissection to the level of the pubic bone on either side. The midline was marked just above the suprapubic region with a sterile marker. A 27 Pratt dilator was placed into the bladder urethrally for manipulation of the bladder throughout the procedure.

The bladder was deviated to the patient`s left while performing the procedure first on the patient`s right. The tension free vaginal tape needle was covered with a plastic sheath. The needle was gently guided to the right of the urethra, behind the pubic bone and out suprapubically within 2cm of the midline. The needle was removed and the needle sheath left in place. The needle was reloaded with the second plastic sheath ensuring the mesh was not twisted. The bladder was deviated to the patient`s right and the tape needle gently guided to the left of the urethrea, behind the pubic bone and out suprapubically within 2 cm of the midline. The needle was removed.

Cystoscopy was undertaken using 250ml of normal saline and both a 0 and 70 degree lens. Examination of the entire bladder showed no evidence of any injury or penetration of the needles into the bladder. Both ureteric jets were easily seen. The cystoscope was removed. Kelly clamps were placed on the plastic sheaths of the mesh on either side. A 27Pratt dilator was placed between the urethrea and the vaginal meash. Independently, each mesh was pulled up through the suprapubic sites by grasping the plastic sheaths until they were removed and appropriate placement of the mesh underneath the urethra was ensured. The pratt dilator was removed and good spacing between the urethra and the mesh was noted. The vaginal mucosa was then closed with a running locked 0 vicryl suture for complete hemostasis. The procedure was completed at this point.

The puncture sites above the pubic bone were cleaned and sealent applied. An island dressing was then placed. The bladder was emptied for clear urine. At the end of the procedure all sponge, needle, and instrument counts were correct. There were no complications. The patient was then transported to the recovery room in stable condition.