Outcomes of Catheter-Free TVT-O Surgery: A Single-Center Case Series

Objectives: Stress urinary incontinence (SUI) significantly affects quality of life. Routine catheterization during and after mid-urethral sling surgery may increase morbidity, and its necessity remains uncertain. This study aimed to evaluate the safety and outcomes of transobturator tape (TVT-O) procedures performed without intraoperative or postoperative catheterization in women with SUI and to compare complication rates with published data. Methods: This retrospective single-center cohort included 1587 women who underwent standardized tension-free vaginal tape (TVT)-O surgery using a modified inside-out approach between 2013 and 2023, without intraoperative or postoperative catheterization. All procedures were performed by a single experienced surgeon. Follow-up included clinic visits and structured telephone interviews on postoperative day 1, at 1 month, and at 4 months. Outcomes assessed included complications, voiding dysfunction, urinary tract infection (UTI), mesh-related issues, and patient satisfaction. Results: Mean operative time was 18.8 minutes with minimal blood loss. Intraoperative complications were rare (0.8%), and no bladder or urethral injuries occurred. Postoperative complications were observed in 8.8% of patients, most commonly UTIs (2.2%), mesh-related issues (0.9%), and urinary retention (1.7%). Among women without baseline overactive bladder (OAB), de novo OAB occurred in 4.5% at 1 month and 9.7% at 4 months; among those with preexisting OAB, symptoms resolved in 87.7% and 72.3%, respectively. The objective failure rate was 3.3%, and subjective dissatisfaction was reported by 2.3% of patients. These findings indicate low early complication rates in this single-center catheter-free cohort, although no direct comparison with catheter-based protocols was performed. Conclusion: In this large single-center retrospective series, catheter-free TVT-O performed by an experienced surgeon was associated with low early complication rates and favorable short-term patient-reported outcomes. These findings suggest feasibility in selected patients but require confirmation in prospective comparative studies with longer follow-up and validated outcome measures.