Tension-free vaginal tape for stress incontinence in women

Surgery Overview

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Stress incontinence in women can cause frequent involuntary release of urine during activities that put pressure on your bladder, such as coughing or laughing. The tension-free vaginal tape (TVT) procedure is designed to provide support for a sagging urethra so that when you cough or move vigorously or suddenly, the urethra can remain closed with no accidental release of urine.

In TVT surgery, a meshlike tape is placed under your urethra like a sling or hammock to keep it in its normal position. The tape is inserted through tiny incisions in your abdomen and vaginal wall. No sutures are required to hold the tape in place. TVT surgery takes approximately 30 minutes and may be done under local anesthesia so you can cough at the surgeon's request to test the tape's support of your urethra.

What To Expect After Surgery

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Usually within hours of your surgery, you will be asked to urinate to test the response of your bladder and urethra to the surgery. You may be released to go home the same day as your surgery, or you may remain in the hospital overnight. It may be necessary to have a thin, flexible tube (catheter) placed into your bladder through your urethra to allow urine to drain while you recover or to teach you to perform self-catheterization temporarily.

TVT surgery usually causes minimal pain and discomfort. Although you may resume most normal activities within 1 to 2 weeks, you will be advised to refrain from driving for 2 weeks and from sexual intercourse or strenuous activities for 6 weeks.

Why It Is Done

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Tension-free vaginal tape is used to correct stress incontinence caused by sagging of the urethra. It is a relatively simple procedure that can be done with minimal hospitalization and recovery time. In addition, TVT has been shown to be effective in relieving stress incontinence in women who are obese and have increased pressure on the bladder and urethra.¹

How Well It Works

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Tension-free vaginal tape surgery can be an effective and relatively noninvasive treatment for stress incontinence. A recent study reported a cure rate between 85% and 87%, with an additional 4.5% to 7% of participants reporting improvement in symptoms.²

TVT appears to be a safe and effective treatment for obese women with stress incontinence. One study reports that 89% of obese women who had TVT surgery were cured of stress incontinence, while 11% experienced improvement in their symptoms.¹

Risks

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There is a risk of a bladder puncture (perforation) with tension-free vaginal tape surgery. The risk of bladder puncture appears to be higher from the TVT procedure than from other treatments for stress incontinence; however, this sort of injury is often relatively minor.³ The surgeon will perform a cystoscopy to be sure that the bladder is uninjured.

Some women may experience either retention of urine or urgency to urinate after TVT surgery.⁴

All surgeries carry some risk of infection or other complications.

What To Think About

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Transobturator (TOT) surgery is like TVT surgery. But because it is newer, experts can't yet say whether it is safe and long-lasting.⁵

Tension-free vaginal tape procedure is not done for pregnant women or for women who have a urinary tract infection.

Before having surgery for urinary incontinence, ask your doctor about the following:

• How much success has the doctor had in treating incontinence with surgery? The success of surgical procedures for urinary incontinence depends on the experience and skill of the surgeon.
• Is there anything you can do to increase the likelihood of a successful surgery? Losing weight, quitting smoking, or doing pelvic floor (Kegel) exercises prior to surgery may increase the likelihood of regaining continence after surgery.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Mukherjee K, Constantine G (2001). Urinary stress incontinence in obese women: Tension-free vaginal tape is the answer. British Journal of Urology International, 88(9): 881–883.

2. Rardin CR, et al. (2002). Tension-free vaginal tape: Outcomes among women with primary versus recurrent stress urinary incontinence. Obstetrics and Gynecology, 100(5): 893–897.

3. Ward K, Hilton P (2002). Prospective multicentre randomised trial of tension-free vaginal tape and colposuspension as primary treatment for stress incontinence. BMJ, 325(7355): 67.

4. Onwude J (2005). Stress incontinence, search date January 2006. Online version of Clinical Evidence (14): 1–4.

5. American College of Obstetricians and Gynecologists (2005). Urinary incontinence in women. ACOG Practice Bulletin No. 63. Obstetrics and Gynecology, 105(6): 1533–1545.

Credits

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Author	Kathe Gallagher, MSW
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Associate Editor	Terrina Vail
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer	Avery L. Seifert, MD - Urology
Last Updated	September 22, 2006