TENSION FREE VAGINAL TAPE

Notice:
TVT procedure is currently suspended.  NHS England announced a national 'pause' on use of TVT tape to treat stress urinary incontinence. Read more...

What is a tension free vaginal tape?

The Tension-free Vaginal Tape (TVT) is a minimally invasive surgical procedure to treat urinary stress incontinence.

How does it work?

The TVT operation works by supporting the middle of the urethra with a polypropylene tape.

Normally, the urethra is supported by the pelvic floor muscle to maintain a tight seal and prevent involuntary urine loss. In women with stress incontinence, the weakened pelvic floor muscle and connective tissue can't support the urethra in its normal position.

Is a TVT operation suitable for all women with stress incontinence?

It is suitable for women who leak because of stress incontinence - urinary incontinence that occurs with activity such as running, laughing, sport and walking. The cause of urine leakage can usually be diagnosed by performing a urodynamic test; this is carried out on all women before a TVT operation is performed.

A TVT operation is usually not recommended for a woman who may want to have a further pregnancy, as this may cause the woman to become incontinent again.

How successful is the TVT operation?

Reported success rates vary between 70% and 95%. The best scientific study to date has shown a satisfaction rate of 85%, measured 6 months after surgery. However, the satisfaction rate is lower in women who have had previous surgery for stress incontinence or who have other bladder problems, such as an overactive bladder or difficulty emptying their bladder.

How is the TVT operation performed?

The operation can be performed using either a general anaesthetic or a regional (spinal) anaesthetic. A small 1 cm incision is made in the vagina underneath the urethra and two 0.5cm incisions are made at the bottom of the abdomen beneath the pubic hair line. A ribbon-like strip of mesh is inserted under the urethra to provide support.

A telescope (cystoscope) is inserted through the urethra into the bladder to make sure that there is no bladder injury. Dissolving stitches are placed in the incisions. Most patients do not require a catheter and go home the same day.

What is the recovery after surgery like?

Many women can go home on the day of the operation, especially if it is done in the morning. The patient goes home when the nurses are happy that she is emptying her bladder well, any vaginal bleeding is not heavy, and any discomfort is controlled. The effects of the anaesthetic will usually wear off after 24 hours. There will then be some discomfort at the operation site and the patient will need to take painkillers for several days. Paracetamol and/or Ibuprofen (Nurofen) are usually sufficient.

Most women need two weeks off work, or four weeks if the job is strenuous. Heavy lifting should be avoided for six weeks.

Further information

For more information about recovering from the operation, and what to expect on going home, read our information leaflet: Vaginal mesh tape procedure

External links

TVT device TVT showing support of the urethra