Tension-Free Vaginal Tape
The Tension Free Vaginal Tape (TVT) is an operation for the management of stress urinary incontinence.
Originally developed in Sweden around 1995, it rapidly became a gold standard procedure for the treatment of stress incontinence.
Long term studies show the 10 year success rate to remain high at 85-90%. Importantly, the success rates appear to be maintained over time. This procedure has a low morbidity, however, no surgery is without risk.
In August 1999, Prof. Nilsson (Finland) toured Australia teaching this technique in selected hospitals. North West Private was fortunate to be the first stop on this teaching tour. He and I performed 4 cases at that time, under local anaesthetic! (see Australian Doctor 17th March 2000)
I have now performed hundreds of these operations (now called TVT exact) and have a 90% success rate (NOT 100%).
I advise women that while no procedure is 100% successful, 8-9 out of 10 are cured or have an 80-90% improvement. If you leak a lot, it is easy to demonstrate this improvement. If you only leak a drop occasionally then you may still achieve this result, but it is very hard to demonstrate.
This procedure involves minimal trauma and much lower complication rates than traditional surgery. There is usually only a minor interruption to normal activities but the usual 'no heavy lifting' applies. You can drive a car in 3 days (assuming you could drive to start with).
The procedure involves placement of a prolene mesh (yes, that type of mesh) tape around the mid-urethra with the ends of the tape passing upwards behind the pubic bone.
The tape places no tension on the urethra because there a gap is left between the tape and the urethra.
The serrated edge of the tape grips the para-urethral tissues and allows the tape to remain firmly in place without suturing. The tape is placed under a general anaesthetic and utilises 3 small incisions. The entire operation takes about 30 minutes and there is minimal discomfort.
Originally designed as a 'day case' procedure, I sometimes keep women overnight as occasionally they require pain relief or have difficulty voiding due to swelling.
Cost is always an issue, but fortunately the device (prolene mesh tape - 1cm wide, with needles attached at each end) is only $700 and fully rebateable from Private Health Funds.
For the uninsured patient this is still cost effective when compared with at least 5 days ($220 per day intermediate) in hospital for a traditional Colposuspension (Bladder Neck Suspension), assuming there are no problems.
Urodynamics is an important investigation prior to undergoing surgery, which helps to determine if you would benefit from an operation and determine what potential problems you may run into when recovering from the procedure.
Risks & Complications: Serious complications are rare with this type of surgery; however the main potential complications are:
10 -15 % failure rate but I believe it is lower if every patient has been assessed with urodynamics
Perforation of the bladder - less common with experience, this is more likely to occur in those with previous surgery for continence or prolapse.
Tape too tight - even in experienced hands the adjustment between too tight and too loose may be measured in millimetres. If you cannot empty properly by the next day, I send you home with a catheter for a week. If you still can’t empty properly, then we return to theatre and loosen / cut the tape. This equates to a 1-5% voiding difficulties necessitating catheters after the surgery. This really includes the
Re-Operation to loosen or cut the tape occurs in 1%
Bleeding - is uncommon but there are some big veins behind the pubic bone and impressive bruising can result. Increased pain can result from this and so I tend to keep women overnight if I think this is an issue.
Urinary urgency & frequency - occurs in about 8% of women and mostly resolves over 6 weeks. It more often is present prior to surgery and usually indicates a slightly higher risk of failure.
1-5% urinary tract infections, which is not surprising if we are fiddling with the urinary system.
1% risk of wound infection
<1% risk of blood clots in the legs or chest
Tape exposure - sometimes the tape can work its way through the vaginal wall and become exposed. This is more common with the older patient but occurs in 1-3% of patients overall.
<1% risk of pain or infection that may require removal of the tape
There are alternative procedures for the management of urinary incontinence.
Please go to this link and review the possible pathways for treatment.
https://urogynaecology.com.au/ugsa-surgical-treatment-of-sui-pathway-2016/