Tension-Free Vaginal Tape (TVT)

This is the most popular procedure to correct stress urinary incontinence in women. It is minimally-invasive with a high cure rates (> 95% success) and minimal complications provided it is done by surgeons trained in continence surgery.

Stress incontinence due to hypermobile urethra

A prolene-material tape is placed under the mid-urethra to re-support it. The tape is inserted via a short incision over the vagina and exits through 2 small skin incisions over the suprapubic area. It is then adjusted to a point of minimal leak. The surgery takes 30 mins to do. Cystoscopy is also performed to check for any accidental puncture into the bladder. Although this surgery is a day case that can be done under local anaesthesia and sedation, many women prefer to undergo general anesthesia.

TVT position

A variant of the TVT surgery is the TOT in which the tape exits through the inner thigh rather than through the top. The results are the same, with the advantage of less risk of bladder injury in exchange for thigh pain. Surgeon experience and judgement are the most important factors for success.

TVT procedure

Complications include:

  • bloody urine. This should clear in a few days.
  • haematoma ((blood clot) in pelvis or bruising over the lower abdomen. This resolves with time.
  • bladder injury.This occurs during passage of the tape. If so, the catheter has to be kept for a longer period.
  • difficulty passing urine. This may be due to the tape being too tight. If this does not settle by 2 weeks, loosening of the tape may be needed.
  • tape erosion into the vagina or urethra. This is a rare and late complication. The tape will have to be removed if this happens.

Desired outcomes:

  • minimal haematoma / bleeding
  • no bladder injury ( < 8% of cases )
  • no urinary retention post-op ( < 3% cases )
  • no more stress leak ( > 95% success )