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Urinary incontinence - tension-free vaginal tape

Definition

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

Alternative Names

TVT; Urethral suspension

Description

You have either general anesthesia or spinal anesthesia before the surgery starts.

  • With general anesthesia, you are asleep and feel no pain.
  • With spinal anesthesia, you are awake but from the waist down you are numb and feel no pain.

A catheter (tube) is placed in your bladder to drain urine from your bladder

A small surgical cut (incision) is made inside your vagina. Two small cuts are made in your belly just above the pubic hair line.

A special manmade (synthetic) tape is passed through the cut inside the vagina. The tape is then positioned under your urethra. One end of the tape is passed through one of the belly incisions. The other end of the tape is passed through the other belly incision.

The doctor then adjusts the tightness (tension) of the tape just enough to support your urethra. This amount of support is why the surgery is called tension-free. If you do not receive general anesthesia, you may be asked to cough. This is to check the tension of the tape.

After the tension is adjusted, the ends of the tape are cut level with the skin at the incisions. The incisions are closed. As you heal, scar tissue that forms at the incisions will hold the tape ends in place so that your urethra supported.

The surgery takes about 2 hours.

Why the Procedure Is Performed

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

Before discussing surgery, your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried these and are still having problems with urine leakage, surgery may be your best option.

Risks

Risks of any surgery are:

Risks of this surgery are:

  • Changes in the vagina (prolapsed vagina in which the vagina is not in the proper place)
  • Damage to the urethra, bladder, or vagina
  • Erosion (breaking down) of the tape
  • Fistula (abnormal passage) between the vagina and the skin
  • Irritable bladder, causing the need to urinate more often
  • It may become harder to empty your bladder, and you may need to use a catheter
  • Pubic bone pain
  • Urine leakage may get worse
  • You may have a reaction to the synthetic tape

Before the Procedure

Tell your doctor or nurse what medicines you are taking. These include medicines, 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 medicines 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 likely be asked not to drink or eat anything for 6 - 12 hours before the procedure.
  • Take the medicines 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. Be sure to arrive on time.

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 have gauze packing in the vagina after surgery to help stop bleeding. It is usually removed a few hours after surgery.

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

Follow instructions about how to care for yourself after you go home. Keep all follow-up appointments.

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

Appell RA, Dmochowski RR, Blaivas JM, Gormley EA, et al. Female Stress Urinary Incontinence Update Panel of the American Urological Association Education and Research. Update of the AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906-1914.

Dmochowski RR, Padmanabhan P, Scarpero HM. Slings: autologous, biologic, synthetic, and midurethral. In: Wein AJ, Kavoussi LR, Novick AC, et al., eds. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 73.


Review Date: 12/12/2012
Reviewed By: Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.
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