Midurethral Sling (Tension-free Vaginal Tape (TVT)) for Urinary Incontinence

You have been diagnosed with urinary stress incontinence, which is leakage of urine occurring during increased pressure on the bladder (cough, laugh, exercise, etc). This condition is due to weakness in the muscles and ligaments of the pelvic floor that support the urethra (urine channel that you urinate through). You and your surgeon have agreed that you would benefit from a surgical procedure called a tension-free vaginal tape.

What Is It and How Does It Work?

A midurethral sling is a surgical procedure where a thin woven mesh tape (about 1 cm wide) is placed loosely under the urethra. The mesh is made out of polypropylene and does not dissolve. During times of increased pressure on the bladder this tape provides support to the urethra, causing it to close and thus preventing leakage of urine.

How well does it work?

  • If you have stress urinary incontinence (SUI), you have an 85% chance of success with this procedure (defined as 1 or less thin pad per day) and 70% of patients are completely dry. Satisfaction rates are greater than 95%.
  • This is the best treatment option available to patients with stress incontinence.
  • This operation does not work in all patients and it is difficult to predict who will have an unsuccessful result.
  • These tapes have been in use since 1997. Long-term data on how long they work is still being collected. It seems that women who have a successful result initially are still doing well 10 years later. In our experience, only a small proportion of women have worsening of their incontinence within 5 years of surgery.

What Happens During the Surgery?

  • It is done in the operating room and takes about 20 minutes to complete.
  • You will be under either a general or spinal anesthetic.
  • You will be able to go home the same day.
  • The procedure is done through a one-inch incision inside the vagina and two smaller incisions in the lower abdomen (5mm in size). You may notice a blue suture fall out of the vagina several weeks after the surgery.
  • Incisions are closed using dissolvable sutures.

What are the risks?

  • Bleeding. Less than one in every one hundred patients may lose too much blood and require a blood transfusion.
  • Infections around the incision site. Antibiotics are prescribed for this.
  • Difficulty urinating. 5-10% of women will find it difficult to completely empty the bladder in the first few days after surgery due to swelling and pain. In 1% of women the difficulty will persist and a catheter is needed to drain the bladder. In these cases the sling can be loosened by a simple procedure that takes a few minutes as long as it is done in the first two weeks after surgery. IT IS CRITICAL THAT YOU LET YOUR SURGEON KNOW IF YOU CANNOT URINATE OR ARE DEPENDENT ON SELF CATHETERIZATION FOR MORE THAN 3 DAYS.
  • Vaginal erosion. If the skin of the vagina doesn’t heal the sling may remain exposed. In rare cases, this requires surgery.
  • Bladder perforation. We always look in the bladder to ensure this hasn’t happened. If it has the tape can be repositioned without any permanent damage. Occasionally a foley catheter is used to drain the bladder for a few days if a perforation happens.
  • Urgency and frequency of urination. These problems are NOT cured by a TVT and in fact can be caused or made worse by a TVT in 10% of women.

What Happens After surgery?

  • You will be discharged home once you have urinated.
  • You’ll be asked to void (urinate) every two or three hours. This is just to make sure the sling isn’t too tight and it isn’t restricting your ability to urinate.
  • You might experience increased frequency of urination, urgency, a slower stream or changed stream for the first two weeks. If your stream is very slow please call the office immediately as the sling can be loosened in the first 2 weeks.
  • You will be given a pain killer for pain control but pain is usually not severe after this procedure.
  • Vaginal bleeding is common as the skin heals itself for the first 1-2 weeks.
  • Vaginal discharge and discomfort is also common.
  • You MUST NOT exercise, soak in baths, use a tampon, or have sexual intercourse for 6 weeks after surgery.
  • You MUST NOT DO ANY HEAVY LIFTING (>20 lbs) OR LUNGING for 6 weeks after surgery to allow the sling to heal in the correct location.
  • Depending on your job requirements you will want to take at least 1 week off work.

There are no dietary restrictions during your recovery period. Keep monitoring your urination and be vigilant when it comes to any potential problems.

Should You Visit Your Doctor?

In most cases, you won’t need to visit your doctor until a designated appointment. If you experience any of the following symptoms, visit your doctor:

  • An inability to urinate or very slow stream
  • Heavy vaginal bleeding or serious blood clotting in the vagina.
  • Bright red blood in your urine.
  • A fever over 38.5 degrees Celsius. This is the most common sign of an infection caused by the surgery. Look for swelling and redness around the incision sites.
  • Severe pain. Use painkillers, but if these don’t work it’s time to visit your doctor.

Call our office to make a follow up appointment for 6-8 weeks after surgery.

 

Michelle Strovski, Maple Ridge Urology, Serving Maple Ridge, Coquitlam, Mission, Abbotsford, Langley, and Vancouver.