Urinary incontinence - tension-free vaginal tape

Definition

Placement of tension-free vaginal tape is a procedure to help control stress incontinence, urine leakage that can happen when you laugh, cough, sneeze, lift things, or exercise. The procedure helps close your urethra (the tube that carries urine from the bladder to the outside) and the bladder neck (the part of the bladder that connects to the urethra).

See also:

• Urinary incontinence - collagen implants
• Urinary incontinence - retropubic suspension
• Urinary incontinence - vaginal sling procedures

Alternative Names

TVT; Urethral suspension

Description

You will have either general anesthesia or spinal anesthesia before the vaginal tape is put in place. In general anesthesia, you will be asleep and feel no pain. In spinal anesthesia, you will be awake but numb from the waist down, and you will not feel pain.

A catheter (tube) will be placed in your bladder to drain urine from your bladder.

A small incision (cut) is made in your vagina, just below the opening that urine passes through. Two small incisions (a little more than a 1/2 inch) are made in your belly just above your pubic hair line or in your groin.

A special synthetic (man-made) tape is passed through one of the cuts in your belly or groin. It is passed under your urethra, and then back up through the other cut in your belly or groin.

The doctor then adjusts the tension (tightness) of the tape so you will not leak anymore. If you do not receive general anesthesia, you may be asked to cough.

The surgery will take about 2 hours.

Why the Procedure Is Performed

Tension-free vaginal tape is placed to treat stress incontinence.

Most of the time, your doctor will try drugs and bladder retraining before talking about surgery with you.

Risks

Risks for any surgery are:

• Incision infection and the incision opens up
• Breathing problems
• Bleeding
• Other infection

Risks for this surgery are:

• Damage to the urethra, bladder, or vagina
• It may be harder to empty your bladder. Or you may not be able to empty your bladder and need a catheter.
• Urine leakage may get worse.
• You may have a reaction to the synthetic tape.
• Erosion (breaking down) of tape
• Irritable bladder, where you may feel the need to urinate more often
• Changes in the vagina (prolapsed vagina, where the vagina is not in the proper place)
• Pubic bone pain
• Fistula (or connection) between the vagina and the skin

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Arrange for a ride home and make sure you will have enough help when you get there.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital. Usually it will be a few hours before the time your procedure is scheduled for.
• You may receive an enema.

After the Procedure

You will be taken to a recovery room. The nurses will ask you to cough and take deep breaths to help clear your lungs. You will have a catheter in your bladder. This will be removed when you are able to empty your bladder on your own.

You may go home on the same day if there are no problems.

Outlook (Prognosis)

Urinary leakage decreases for most women who have this procedure. But you may still have some leakage. This may be because other problems are causing your incontinence. Over time, some or all of the leakage may come back.

References

Dmochowski R, Scarpero H, Starkman J. Tension free vaginal tape procedures. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders; 2007:chap 68.