Tension-free vaginal tape (TVT) is one of many surgical methods used to treat stress incontinence. Tension-free vaginal tape is a "vaginal tape" that doctors insert vaginally. After preliminary examinations and with the correct indication, TVT sling surgery is a minimally invasive and low-risk method of treating stress incontinence.
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Tension Free Vaginal Tape (TVT) - Further information
When is a Tension-free Vaginal Tape (TVT) recommended?
In the case of stress incontinence, involuntary urine leakage occurs during physical exertion.
This occurs with
- Coughing
- sneezing
- lifting
- jumping
- Climbing stairs
- Standing up
The cause is a weakness of the urethral sphincter muscles.
Stress incontinence is usually categorized according to Stamey:
- Grade I: Involuntary loss of urine during heavy physical exertion (e.g. coughing, sneezing, straining)
- Grade II: Involuntary loss of urine during light physical exertion (e.g. running, climbing stairs, changing position)
- Grade III: Involuntary loss of urine at rest and when lying down
The following tests are used to diagnose stress incontinence, depending on how invasive they are:
- Medical history
- Micturition diary
- Urinalysis (Stix, Uricult)
- Prolapse test
- Vaginal adjustment and pH measurement
- Karyopyknotic index
- Urethral and bladder endoscopy (urethrocystoscopy)
- Cough provocation test with full bladder
- Urodynamics (cystometry with urethral pressure profile)
Grade I stress incontinence is usually treated conservatively and with medication. Surgical treatment (e.g. insertion of a TVT) is usually reserved for more severe forms of incontinence.
What is a Tension-free Vaginal Tape (TVT)?
Tension-free vaginal tape (TVT) is a suprapubic alloplastic sling ("vaginal tape") that doctors insert vaginally.
Alternative methods are:
- The transobturator sling (TOT)
- The abdominal surgical procedure (lower abdominal incision)
- Colposuspension according to Burch and
- The autologous pubovaginal sling (lower abdominal incision: fascial reinplasty)
In TVT and TOT surgery, doctors implant a tension-free vaginal tape through the vagina to eliminate urinary incontinence @ sayukichi /AdobeStock
Ulmsten and Petros first developed this surgical method in the early 1990s.
Doctors insert the polypropylene tape vaginally via a small incision in the anterior vaginal wall up to the abdominal wall. There they insert it without tension.
These tapes support the sphincter apparatus like a hammock under the urethra. They form an abutment that leads to fibrosis (ingrowth of the body's own connective tissue) along the ligament structures.
This limits the hypermobility of the urethra and improves continence. Continence rates reach around 80 percent after 10 years of follow-up.
It is estimated that a weak bladder occurs in one in five women @ doucefleur /AdobeStock
Possible complications and risks of TVT slings
The TVT slings are foreign material. Foreign body reactions with excessive scarring and corresponding pain can therefore occur.
Doctors can primarily injure and perforate neighboring organs such as the urinary bladder during insertion. Pronounced bleeding (sometimes requiring transfusion) and hematoma formation is also possible in rare cases.
Furthermore, the polypropylene tape can lead to erosion or penetration of the urethra, bladder and/or vaginal mucosa. This means that the tape cuts through the urethra, bladder or vaginal wall.
In such cases, doctors have to surgically remove the ligament. They reconstruct the defects. They may then have to perform another incontinence operation using the body's own material.
The following consequences are also possible:
- Recurrence of urge symptoms
- Urge incontinence
- Overcorrection with subsequent urinary retention
- Performance of a single-use catheterization