Tension Free Vaginal Tape (TVT)
Is a TVT operation suitable for all women with stress incontinence?
No. It is suitable for women with stress incontinence that occurs with activity e.g., running, laughing, sport and walking.
A TVT is usually not recommended for women who want to have a further pregnancy, as this may cause the woman to become incontinent again.
How successful is a TVT?
Success varies between 70-95%. The best scientific study to date has shown a satisfaction rate of 85% 6 months after surgery. However, the satisfaction rate is lower in women who have had previous surger or who have other bladder problems, such as an overactive bladder or difficulty emptying their bladder.
How is it performed?
The operation can be performed using either a general anaesthetic or a regional (spinal) anaesthetic. A small 1 cm incision is made in the vagina underneath the urethra and two 0.5cm incisions are made at the bottom of the abdomen beneath the pubic hair line. A ribbon-like strip of mesh is inserted under the urethra to provide support.
A cystoscope is inserted through the urethra into the bladder to make sure that there is no bladder injury. Dissolving stitches are placed in the incisions. Most patients do not require a catheter and go home the same day.
What is the recovery after surgery like?
Many women can go home on the day of the operation, especially if it is done in the morning. The patient goes home when the nurses are happy that she is emptying her bladder well, any vaginal bleeding is not heavy, and any discomfort is controlled. The effects of the anaesthetic will usually wear off after 24 hours. There will then be some discomfort at the operation site and the patient will need to take painkillers for several days. Paracetamol and/or Ibuprofen are usually sufficient.
Most women need two weeks off work, or four weeks if the job is strenuous. Heavy lifting should be avoided for six weeks.
Complications, including sling erosion (into either the vagina or bladder/urethra), suprapubic abscesses, and urethral sloughing, are rare. However, as with any other sling procedures, the risk of urinary retention still exists. Urethral obstruction secondary to TVT should be treated aggressively with urethrolysis within the first 3-6 weeks because the likelihood of spontaneous voiding without urethrolysis is rare. The same applies for other synthetic mid-urethral slings placed in an antegrade fashion.
Transobturator Tape Sling
The transobturator tape (TOT) sling procedure is similar to the TVT procedure; however, the needle passers are placed in the medial portion of the obturator canal inside the groin creases at the level of the clitoris laterally. Tensioning is performed in much the same way as with TVT, and the sling is placed in a tension-free manner (see the image below). Care should be taken to keep from "buttonholing" the lateral aspect of the vagina at the level of the vaginal fornices.Transobturator sling.