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TVT procedure

What is the TVT procedure?

TVT (Tension-free Vaginal Tape) procedure is a surgery to help women with stress incontinence – the leaking of urine when coughing, sneezing or moving. Stress incontinence is caused by a weakening of the ligaments which support the urethra (the tube which carries urine from the bladder), caused by pregnancy, aging, a chronic cough, heavy lifting and being overweight.

What is the procedure?

TVT operation works by supporting the middle of the urethra with a tape. The tape is made of a synthetic mesh and has a long needle at either end. An incision is made in the vagina underneath the urethra and two small incisions are made at the bottom of the abdomen beneath the pubic hair line. The needles are passed upwards from the vagina so that the tape comes to lie underneath the urethra.

A telescope (cystoscope) is inserted through the urethra into the bladder to make sure that there is no bladder injury. The tape is then placed in the correct position and the needles are removed. Dissolving stitches are placed in the incisions.

TVT procedure can be performed under local anesthesia and sedation as well as under general or spinal anesthesia.

What kind of result can you expect?

Most of women are happy with their surgery and feel that their incontinence is a lot better. The surgery is less likely to be successful if a woman has had previous surgery of the bladder.

Recovery period and recommendations

Most women experience some pain or discomfort for the first few days after the surgery, but painkillers can easily relieve it.

Some patients have difficulties emptying their bladder immediately after the surgery. You may need a tube (catheter) to empty your bladder. The catheter is usually removed the day after the surgery.

Occasionally the bladder takes longer to return to normal. In this case, although rare, you may need to be taught to put a catheter into your bladder to empty it yourself (called “intermittent self catheterization”). This is usually a short term problem and you should generally stop using the catheter after a week or so. If the problem persists longer, the surgeon is likely to discuss with the patient the option of loosening the tape.

Because major incisions are avoided, recovery is quite quick and usually takes 1 to 4 weeks.

Patients should avoid heavy lifting and sport for 6 weeks to allow the wounds to heal properly and the mesh to settle into place.

Patients are usually advised to wait for 4 weeks after the surgery before having sexual intercourse.

Possible side effects and complications

As with any surgery there is a risk of complications. The following complications can occur with a TVT:

- bladder perforation. During the surgery the needles which are used to make sure the mesh is positioned correctly may accidentally pierce the bladder. If such case happens, the needle will be removed and repositioned. A tube (catheter) will be put into the bladder to drain the urine;

- hematoma. Occasionally a small blood vessel is punctured where the needles go through the skin. This causes small lump (hematoma) that should get better by itself;

- severe bleeding. Rarely there can be severe bleeding;

- bladder infection, causing symptoms of burning on passing urine. Usually it is easily cured by taking antibiotics;

- passing urine frequently. The TVT procedure is unlikely to cure symptoms of passing urine frequently and needing to rush to the rest room urgency. If you have these symptoms as well as stress incontinence you should be aware that these symptoms are likely to persist and may even worsen by the surgery;

- as the tape is a foreign body there is a risk of wearing through the vagina. If it happens, it can cause a vaginal discharge and the problem is usually helped by trimming the mesh and re-stitching inside the vagina;

- inability to empty the bladder properly (voiding difficulty). This is fairly common in the first few days after the surgery but usually settles as any bruising and swelling around the tape subsides;

- in very rare cases complications of bowel and nerve trauma occur.

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