TVT or TVT-O

These are procedures for urinary stress incontinence. However, they have become very controversial as they use mesh & some patients have great trouble with pain, mesh erosion, worsening of urinary urgency and other non-specific symptoms following their operation.

Given the problems with mesh operations, both these procedures are now best done within a multidisciplinary subspecialist urogynaecological service & after full urodynamic assessment & consideration of the potential long-term risks. We have never performed TVTs or TVT-Os in this practice. However, they can be very successful for selected patients, so there is still a place for them. The alternatives (eg. fascial sling, Burch colposuspension) also have their own risks & problems.

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 definitely recommended. TVT can often 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 (or even higher)
  
• chronic pain in thighs, pelvis or vagina due to the tape.

When the tape is in it can be VERY difficult to remove, especially the TVT-O. 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.

Alternatives to TVT

• Pelvic floor training
• If a prolapse is present, a vaginal repair can often help the bladder. We do this quite regularly.
• Burch colposuspension
• Laparoscopic colposuspension
• Autologous sling using patient’s own tissue

Generally speaking, the use of TVT is now 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 do not offer TVT. If you have exhausted other options, we will likely refer you for subspecialist assessment if we think you may benefit from surgical management.