Tension Free Vaginal Tape Insertion

Urinary continence depends on the bladder entrance being supported by strong ligaments that hold it up it from the muscles of the pelvic floor.

These ligaments can be torn or stretched, by vaginal child birth, chronic straining due to constipation or by an inherited weakness of the collagen in the ligaments.  If this happens, you may pass urine when you cough, sneeze etc.

The procedure is usually for patients who:

  • Have had a previous but failed operation for genuine stress incontinence
  • Those who are very overweight
  • Those who have major damage to the muscle about the urethra

The procedure usually takes about 30 minutes.  You will get better quite quickly.  Sometimes you may have pain or discomfort about the cuts.  This is treated with painkillers and should only last a few days.

It takes 6 weeks for scars to form.  So you need to take it easy for a few weeks although you may feel well enough to get back to normal.

You should:

  • Only go back to work if this does not involve heavy lifting.
  • Not have sex for 4 weeks after the surgery.

Procedure

The following procedure will be performed:

The damaged ligaments are replaced by a 1 cm wide tape of synthetic mesh.  This tape returns the support for the urethra to the surrounding tissues that had been lost.

The TVT tape is usually put in under local anaesthesia whilst you are under sedation or general anaesthesia

Two 1 cm cuts are made, both in the pubic hair line, one on either side of the middle.  A further 1 cm cut is made just inside and on the front wall of the vagina.

The tape is threaded from the vaginal cut, one half of the tape on each side of the urethra (this is the tube that leads from the bladder to the outside) out through the cut in the pubic hair. This is followed by looking into the bladder, during which time you will be asked to cough.  The tape is slowly tightened until the urine loss with coughing stops.  The tape is cut off and the cuts are all closed.

General Risks Of A Procedure

They include:

(a) Small areas of the lungs may collapse, increasing the risk of chest infection.  This may need antibiotics and physiotherapy.

(b) Clots in the legs with pain and swelling.  Rarely part of this clot may break off and go to the lungs which can be fatal.

(c) A heart attack because of strain on the heart or a stroke.

(d) Death is possible due to the procedure.

The success rate is very high (9 in 10 women).  The long-term success rate is not yet known.

There are some risks/complications, which include:

(a) The bladder may be over-active after the operation.  You may need to go to the toilet a lot, may have sudden urge to pass urine and may leak urine.

These symptoms are usually managed by bladder retraining and drug therapy.  A small proportion of patients will continue to have long – standing bladder symptoms despite treatment.

(b) Problems with passing urine are uncommon.  This rarely needs long term management.  If this happens, the tape may be divided through the vaginal cut. There is a small risk of the urinary incontinence returning.

(c) Infection.

(d) Excessive bleeding. This is rare.

(e) A higher risk in obese people.  This may cause wound and chest infection, heart and lung problems and blood clots in the veins.

(f) A higher risk in smokers. This may cause wound and chest infections, heart and lung problems and blood clots in the veins.