What is TVT?
TVT stands for “Tension free Vaginal Tape” and is the most common type of surgery to treat bladder leaks caused by stress urinary incontinence. The procedure involves inserting a 1 cm wide synthetic tape (also called a sling or mesh) to support the middle part of the urethra. The tape can be inserted either through the abdomen or through the groin. Through the procedure the urethra gets support when there is pressure on the pelvic floor, such as when exercising, sneezing, laughing or jumping, thus preventing urine leakage.
Who can do TVT surgery?
Since a surgery always carries risks and side effects, the TVT procedure is only recommended if other methods have not worked, and you feel that your problems affect your quality of life so much that it is worth the risk. Surgery can be a solution for you if:
- You have been diagnosed with stress urinary incontinence
- Have significant problems with bladder leaks in your everyday life
- Are not planning on giving birth to more children
- Have tried other methods, which does not involve surgery, and they have not worked for you
Wondering if you are incontinent? Take our incontinence test here!
How does the TVT surgery work?
Before a TVT surgery you generally prepare by fasting for about six hours. You can drink small amounts of beverages like water, tea, and coffee without milk up until two hours before the surgery. Right before the surgery you usually get to wash yourself with an antibacterial soap.
The surgery itself takes around 10-30 minutes and is performed as a daytime surgery, without anaesthesia. If you wish, you can get a calming medication. First you get local anaesthesia, then three incisions are made, two by the pubic bone and one through the vagina by the urethra. Then, using a special needle, the tape is inserted through the vaginal incision, around both sides of the urethra and up over the pubic bone. The doctor sews the wound in the vagina with a few stitches and tapes or stitches the skin incisions. There will be two scars about 5mm long by your bikini line.
Below, you can see a picture of what the synthetic tape with its needles might look like (picture 1) and an illustration of how the tape is in place below the middle part of the urethra and out on the stomach, above the pubic bone (picture 2).
Picture 1: Example of a synthetic support tape (TVT) with its insertion needles.
Picture 2: Position of the tape from a TVT surgery (IMS schematic drawing).
What happens after the TVT surgery?
After a TVT surgery you normally stay at the hospital for some hours and then go home during the same day.
Aftercare: You get to meet healthcare professionals who tells you what you should think about after the surgery. The first 24 hours after the TVT procedure you can experience side effects such as pain in your lower abdomen. The stitches usually go away by themselves, but sometimes you may need to make a revisit.
If any complications occur after the surgery, for example, if you have heavy bleedings, smelly vaginal discharge, fever, wounds, or significant pain in your stomach you should contact your doctor.
Normally you won’t need to take any sick leave after your TVT surgery. However, if you have a job which is physically strenuous you may need to take a few days off.
The first three weeks after the procedure you should not do any high intensity activities. Light exercise, like talking a walk, is recommended instead. After that, you can usually go back to exercising more like usual. From there on, you can start with more intense exercise such as gym workouts, spinning, running or horse riding. However, you should not lift heavy weights, use tampons, have sex, or swim the first period of time after the TVT surgery.
What are the risks or side effects of TVT surgery?
TVT surgery usually has good results and 9 out of 10 are cured or have a significant improvement of their incontinence. The TVT surgery usually lasts over 20 years. However, there are risks which are good to be aware of. Although side effects are uncommon, they can cause lifelong problems and be difficult to correct because the tape becomes entrenched and is difficult to remove.
Some of the risks of the TVT surgery include: bladder perforation (during surgery or afterwards due to erosion), urinary tract infections, bladder problems, exposure of the tape in the vagina, and pain during sexual intercourse.
It is therefore important that you ask your doctor for clear information before deciding on a surgery, what the risks are, how common they are, and think about the benefits of getting rid of your urine leakage and weigh the risks with the surgery.
What are the alternatives to surgery?
The first step is to train your pelvic floor muscles. This has been proven to help with stress urinary incontinence in many cases.
One option that can relieve your stress incontinence temporarily, while you are waiting for surgery or if you are unable or unwilling to have surgery, are vaginal aids such as Efemia Bladder Support. It is inserted like a tampon and the support rings support the middle of the urethra – the same spot that the tape used in a TVT operation supports. Contact your health centre to get a start set prescribed or buy it directly here!
You can read more about different treatments for stress urinary incontinence here.