Pearl obstetrics | gynaecology


TVT

  • TVT
    TVT & TVT-O
    An option for stress incontinence if other management isn't working.

TVT or TVT-O | Tape operation | Glengarry | Perth

These are procedures for urinary stress incontinence. However, they have become increasingly controversial as they use mesh & some patients have great trouble with pain, mesh erosion or worsening of urinary urgency following their operation. However, they can be very successful for other patients & recovery is usually quick & uneventful.

It is important to have tried physiotherapy & other measures first before having one of these procedures. If you have mixed incontinence with overactive bladder/urgency, then physiotherapy, bladder retraining/calming, special medication (anticholinergics & local oestrogens), and urodynamics is recommended. TVT can make the urgency worse.

The TVT or TVT-O operation

These procedures are usually performed under general or spinal anaesthesia. A small cut is made inside the vagina and a tape is placed under the tube leading from the bladder – the urethra. The tape is threaded through to come out of your upper inner thigh (TVT-O) or just above your bikini-line (TVT). Satisfaction rates of 80% at 5 years have been reported. The tape is permanent.

Return to activity is usual after a week. There is no heavy lifting for about 6 weeks after the operation.

Risks of TVT and TVT-O

Many of these operations go very well, but in all surgery there is risk.

  • 10-15% failure to solve incontinence
  • 5% of women unable to pee after surgery (this is higher with TVT than TVT-O) – usually gets better with a little time
  • 25% bladder irritability (urgency symptoms) after the surgery – mostly mild (worse with TVT than TVT-O)
  • If you have urgency already, it may get better or worse.
  • 5% urine infection
  • Rarely, with TVT, damage to the bladder or blood vessels
  • 5% immediate wound infection
  • 10-15% risk of mesh erosion or chronic infection
  • potential chronic pain in thighs, pelvis or vagina due to the tape.

 
When the tape is in it can be VERY difficult to remove. Be very sure about this surgery before you embark upon it. Any surgical or invasive procedure carries risks, and this one is no exception. Before proceeding, you should do your own research. You should seek a second opinion from an appropriately qualified health practitioner. For instance, your GP’s, or a urogynaecologist’s opinion will be very helpful.

Alternatives to TVT

  • Pelvic floor training
  • If a prolapse is present, a repair can help the bladder.
  • Burch colposuspension
  • Laparoscopic colposuspension
  • Autologous sling using patient’s own tissue

 
Generally speaking, the use of TVT is moving away from being a routine procedure, towards being a much rarer subspecialist procedure delivered by urogynaecologists practicing with the help of a specialist multi-disciplinary team. The threshold for doing a TVT is now much higher than previously. The procedure can be considered against a colposuspension or autologous sling with the risks & benefits of each operation fully compared. The TVT-O is harder than the TVT to fully remove if there are problems given its anatomical course, so will likely fall out of use despite several advantages over TVT. We are now not able to offer TVT easily given the current environment. If you have exhausted other options, we will likely refer you for subspecialist assessment if we think you may benefit from surgical management.


Stress incontinence

If you leak when you cough, call us for an appointment.


PEARL obstetrics | gynaecology

Our office is situated opposite Glengarry Private Hospital in Perth. We provide easy free parking. We're easily accessible from Joondalup, Hillarys, Stirling, Currambine, Ocean Reef, Beldon, Connolly, Edgewater, Wanneroo, Burns Beach, Sorrento, Padbury, Marmion, Watermans Bay, North Beach, Karrinyup, Gwelup, Carine, Balcatta, Westminster, Mirrabooka, Malaga, Hamersley, Koondoola, Girrawheen, Marangaroo, Greenwood, Warwick, Madeley, Darch, Wangara, Kallaroo, Craigie, Heathridge, Woodvale, Scarborough, Doubleview, Innaloo, Osbourne Park, Wembley Downs, Tuart Hill, Trigg, North Beach. The Western suburbs (Cottesloe, Claremont, City Beach, Floreat, Swanbourne) are all within easy reach.