Tension-Free Vaginal Tape (TVT)

Picture of Tension-Free Vaginal Tape (TVT)

This is the most popular procedure to correct stress urinary incontinence in women because it is minimally-invasive and has a high cure rate (> 90%) with minimal complications. A prolene-material tape is placed under the mid-urethra to re-support it and prevent urine leakage from the bladder. Although it is a day case that can be done under local anaesthesia and sedation, many women prefer to be under general anesthesia. The tape is inserted via a short incision over the vagina and exits out from 2 small skin incisions over the suprapubic area. The surgery takes 30 mins and the pain settles within a week. Surgeon experience and judgement are the most important factors for a good outcome. A variant of the TVT surgery is the TVT-O in which the tape exits through the side rather than through the top.

Complications include:

  • bloody urine. This should clear in a few days.
  • haematoma ((blood clot) in pelvis. This is seen as bruising over the lower abdomen and may be painful. It is usually small and resolves with time. Antibiotics will help prevent infection of the haematoma.
  • bladder injury. This occurs during passage of the tape. If so, the catheter has to be kept for a longer period.
  • difficulty in passing urine. This may be due to the tape being too tight. If this does not settle by 2 weeks, re-adjustment 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
  • low bladder injury ( < 8% cases )
  • no urinary retention post-op ( < 3% cases )
  • no tape adjustment / removal