Therapeutic: Continence Surgery

Tension Free Vaginal Tape (TVT)

The Tension Free Vaginal Tape (TVT) is performed for the management of stress urinary incontinence.

Studies show the success rate to be better than other procedures and this appears to be sustained over time. I have been performing this procedure since 2000 when I first learnt it from one of the pioneers of the technique.

The procedure involves placement of a Polyprolene mesh tape beneath the mid-urethra with the ends of the tape passing upwards behind the pubic bone. The aim is that at rest the tape places no tension on the urethra, but helps to close the urethra when the pressure in your abdomen increases for example when you cough. The operation takes about 30 minutes and you will have three small incisions one in the vagina and two above your pubic hair line. Your discharge after surgery depends on timing of the return of your bladder function. If the TVT was the only surgery performed then this is often a day case procedure but measurements of your bladder function using an ultrasound machine will be required before you are able to go home.

Complications which can occur with TVT:

  • An injury to the bladder – I check for this during the surgery with a telescope and it is not common however if it occurs it can usually be managed by repositioning the tape during the same procedure.
  • The tape may be too tight – there is a method surgeons use to assess how tight to place the tape, but as the operation is performed with you lying in a position you would not normally be in to pass urine it is possible to make the tape a tiny bit too tight in which case the tape may need to be loosened and this can usually be managed fairly easily.
  • You need to be aware it is quite common to experience a slower flow of urine after this surgery. It usually resolves over time.
  • Urinary tract infection – is a risk as the surgery involves putting tubes and telescopes into your bladder. I will ask the anaesthetist to give you an antibiotic during the surgery in an attempt to try to prevent this but this does not always work for everyone.
  • Bruising is sometime seen as there are some quite big blood vessels behind the pubic bone however it is rare to need to do anything about bleeding after this surgery as it usually stops by itself.
  • You may develop the sensation of needing to go to the toilet in a hurry or need to go often initially after this surgery. It is quite common and resolves for most women by 6 weeks. If you had these symptoms before surgery though, they are not usually helped by this procedure and we will have discussed this prior to surgery.
  • Failure of the method to prevent you leaking urine. I do not see this very often, but it is more common if you have a mixture of symptoms and in this situation a physiotherapist consult prior to surgery is extremely important.
  • The Tape erodes through the vaginal skin – this is more common with older women and the risk for this group can be reduced by maintaining the oestrogen level in the vagina. Overall the risk of this occurring after surgery is around 3-5% and it can occur many years later. It is often managed quite simply in the rooms, by trimming the tape.

Trial of Void

After pelvic surgery it is important to make sure that the bladder is emptying correctly. Pain, swelling and bruising can interfere with the mechanism required for bladder emptying to work properly. If the bladder remains too full for too long, this can cause damage to the nerves and muscles in the bladder wall. We can avoid this by monitoring what your bladder is up to after surgery with a specific process which is overseen by the nurses looking after you. So that everyone knows what we mean it is called a Trial of Void, but it just means checking the bladder and urethra are working together correctly.

Once your catheter is removed drink as you would normally (unless you drink very little normally in which case try for a couple of litres a day). You will be asked to pass urine into a container in the toilet so the volume can be measured. Then the nurse will do a scan to see what is left behind in your bladder. It is normal to leave a small amount behind but if you leave a lot behind every time you go then we need to manage that. Most women go to the toilet twice and have a scan twice and then that is the end of it as everything is working okay.

If there is a delay in your bladder emptying properly we have a few options for managing that until the bladder recovers which I will discuss with you. Sometimes, after your catheter is removed, the bladder will fill and despite the fact that you have the urge go to the toilet nothing will come out. Don’t panic. It just needs more time. In this situation we will often reinsert your catheter and wait a bit longer.

Bladders can be a bit tricky and they don’t always tow the line after surgery so be prepared to go with it. The nurses have a lot of experience with this type of thing and will keep you informed along the way of how you are doing.