TVT (Sling) procedures
What are TVT (Sling) procedures?
There are over 150 operations described for the treatment of stress incontinence! Many have not stood the test of time and it goes without saying that the perfect operation that is suitable for all women with a zero complication rate and 100% cure rate has not yet been invented.
TVT (Sling) procedures are innovative, minimally-invasive and simple surgical device alternatives for the effective treatment of female stress urinary incontinence. Clinical studies have demonstrated that 85 percent of patients were dry after treatment and an additional 11 percent reported a significant improvement.
How does the treatment alleviate stress urinary incontinence?
Female stress urinary incontinence is caused predominantly by deficiency in the support &/or an improperly functioning urethra; it is not a problem of the bladder. Normally, the urethra, when properly supported by strong pelvic floor muscles and healthy connective tissue, maintains a tight seal to prevent involuntary loss of urine .
Polypropylene mesh, inserted through the vagina and positioned underneath the urethra, creates a supportive sling. During movement or exercise, the mesh supports the urethra, allowing it to maintain its seal, hence preventing loss of urine . The tape, therefore, uniquely provides support only when needed, without any unnecessary tension on the urethra (‘tensions-free’).
As the tape passes through several pelvic tissue layers, friction is created, which secures the tape in place. Over time, the natural in-growth of tissue into the mesh further secures the tape.
The transobturator approach to the sling procedure
The transobturator approach to the TVT placement has been more recently developed with a view to reducing the risk of injury to the bladder, bowels and blood vessels during placement. Evidence is currently being gathered to see if it is efficacious as the retropubic approach. Current indications are that this newer technique is even safer, quicker to perform and as effective.
What are the key benefits of the TVT (sling) procedure?
This is a relatively simple procedure in comparison to most preceding operations for stress incontinence. A TVT procedure can be completed within 30 minutes under local anesthesia and patients may return home the same day. TVT procedures offer short recovery times with minimal pain. Most patients will not require catheterization after surgery.
Urethral obstruction is less common than most other types of surgery and can easily be managed by either adjusting or dividing the tape (most commonly done back in the operating theatre as a daycase procedure).
A significantly lower complication rate when compared to many surgical treatments currently in use for treating stress incontinence.
Key features of the TVT (sling) procedure
- The tape is open weave rather than close woven, allowing incorporation of tape into tissues rather than fibrosis around tape. This has resulted in a much reduced rejection and erosion rate.
- The tape is flexible in all directions and not rigid.
- The tape is not sutured in position, but held by surrounding tissues.
- Rejection and infection are extremely rare.
- Postoperative urinary retention that lasts more than a few days can be simply treated by simply cutting or loosening the tape.
- The de novo urgency <10%.
- This minimally invasive procedure to insert a sub-urethral Prolene tape sling can be performed under local or regional anaesthesia (or general) with a short operating time, short hospitalization time, rapid recovery (although patients must avoid heavy effort for 6 weeks).
- Cure rate > 89% after 10 years.
- Some evidence it may also help with urinary urgency.
- Suitable for all ages
- Especially good for patients with:
- Short urethra
- Low urethral closing pressures
- Hypermobile urethra
- Intrinsic sphincter deficiency (70% cure rate, vs Burch 45%)
Risks associated with the TVT (sling) procedure
All surgical procedures present risks. Although rare, complications associated with the system include injury to blood vessels of the pelvic sidewall and abdominal wall, difficulty urinating and bladder and bowel injury.
TVT (sling) procedures and pregnancy
As with any surgery of this kind, this procedure should not be performed in pregnant patients. Additionally, because the mesh-like tape will not stretch significantly, TVT slings should be used with caution in women who plan future pregnancy.