TVT (tension-free tape)
Incontinence is not a fatal condition but it can significantly interfere with professional, social, and personal activities with deterioration in the quality of life and sometimes social
isolation. It is, therefore, important and worthwhile to have treatment.
Incontinence can be Cured
There are many different kinds of treatment depending on the cause. Firstly it is important to make sure that there isn't a urine infection (cystitis) as this can sometimes cause temporary incontinence and is easily treated.
If the main complaint is stress incontinence, pelvic floor excercises may be helpful. These have to be practised daily and a cure rate of up to 70% may be expected.
If these fail or are inappropriate, surgery is the next step. Conventional major surgery may achieve a success rate of 85% to 90% but there is usually a 4-6 day stay in hospital and some discomfort from the abdomial wound with an eventual return to work after 4 to 6 weeks.
An alternative approach is to inject bulking agents around the bladder neck (where the ureathra leaves the bladder) to prevent it opening too easily. This procedure may achieve up to 70% success but re-injection may be required.
A technique has been devised which ovecomes the modest success rate of pelvic floor exercises and avoids the pain and long hospital stay of more major operations.
This procedure achieves between 85% to 90% success and has little post-perative pain so the patient leaves the hospital either on the same day or on the following day.
It works by supporting the middle of the urethra.
Gynecare TVT ia an exciting new concept. The mesh consists of a permanent Prolene material surrounded by a plastic sheath with a strong needle at either end. A small cut is made in the vagina and the mesh is passed under the middle of the urethra to support it. Both needles emerge through the anterior abdominal wall so that the mesh is accurately positioned.
A fine telescope (cystoscope) is introduced into the bladder to be absolutely sure there is no bladder injury, and then the position is adjusted and needles are removed.
The vaginal and abdominal wounds are then closed and the patient returns to the ward. The operation takes up to 30 minutes. Some pain relief may be necessary and the patient usually passes urine within a few hours and can return home either the same day or the following day.
Published medical papers show that between 86% and 90% of patients are cured at a three year follow-up. (Ulmsten et al 1999; Olsson 1999).
Complications can include bleeding or bladder injury when the needles are passed, difficulty emptying the bladder, urgency and urinary infection. So far there have been no significant long-term side effects.
QUESTIONS & ANSWERS
- Am I a candidate for TVT?
If you complain of stress incontinence and urodynamic studies have shown that urethral sphincter incompetence is present, then thisoperation is likely to be suitable. It is appropriate for many types of patient, iincluding those who have had previous surgery for incontinence andare overweight. As with any surgery of this kind, the procedure should not be performed during pregnancy and the patient should be counselled that future pregnancies may negate the effects of the surgical procedure and she may again become incontinent.
- Will I have pain after the procedure?
Some mild pain may occur over twenty four to forty eight hours after surgery. This could be controlled by simple pain relief such as aspirin.
- Will I have difficulty emptying my bladder?
A few patients have temporary difficulty and may require an in-out catheter in the ward.
- What is the risk of urinary infection?
This may occur in up to 6% of patients and is treated by antibiotics and an adequate fluid intake.
- When can I play sport?
Usually after 4 to 8 weeks to allow the wounds to heal and the mesh to settle into place.
- When can I have intercourse?
After 4 to 6 weeks.
- Can I return to my usual routine?
Yes after about 1 -2 weeks, but it is wise to avoid unnecessary heavy lifting for 6 weeks.
- When can I drive?
Usually within 1 week of surgery.
- Does the mesh remain there forever?
Yes: evidence fom longterm follow-ups show that it is inert and remains there to support the urethra.
- Are there any side effects from this?
Occasionally a portion of the mesh may be exposed but this is uncommon. It is treated by antibiotics, and closure of the wound.
- What happens if the mesh falls and I become incontinent again?
You would need to be investigated with fresh urodynamic tests and treatment decided on the basis of these. Occasionally a new Gynecare TT has to be inserted.
- Ulmsten U, Johnson P & Rezapour M. 1999. A 3 year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence.
Brit. J. Obstet Gynaecol; 106:345-350.
- Olsson, Kroon 1999. A 3 year postoperative evaluation of tension free vaginal tape.
Gynecol. Ostet. Invest;48:267-269.