Gynaecology - Tension Free Vaginal Tape (TVT)

What is tension-free vaginal tape?

Tension-free vaginal tape is one of the surgical ways of treating stress incontinence in women where conservative management has failed.

The procedure is usually performed whilst you are awake under regional or local anaesthetic, enabling the surgeon to apply the right amount of tension required to stop urinary leakage on coughing.

The surgeon inserts the tape through a small cut on the wall of the vagina, and passes it either side of the urethra creating a supportive sling. You will then be asked to cough. The surgeon will then pull the ends of the tape up through two cuts in the skin’s surface just above the pubic area adjusting the tension as required. At the end of the operation, the tape is snipped just under the skin’s surface and the small cuts are closed with stitches. The stitches can be removed approximately five days after the operation, but will dissolve if left.

The tape supports the urethra, helping to keep it closed and stop urine leaking out when there is a sudden increase in pressure in the abdomen e.g. laughing, sneezing, coughing or exercising.  The tape provides support only when required, without any unnecessary tension on the urethra (this is why it is called tension-free).

Who would be suitable to have TVT?

The National Institute for Clinical Excellence (NICE) has recommended tension-free vaginal tape, as one of a range of surgical options for women with confirmed uncomplicated stress incontinence where non-surgical treatments (such as pelvic floor exercises) have not worked.

What is the National Institute for Clinical Excellence (NICE)?

The National Institute for Clinical Excellence is part of the NHS. It produces guidance for both the NHS and patients on the use of medicines, medical equipment, diagnostic tests, clinical, and surgical procedures and under what circumstances they should be used.

Are all women with confirmed stress incontinence suitable for TVT?

Surgical procedures for stress incontinence, including tension-free vaginal tape, are generally not suitable for women who may go on to have children.

Would any other procedures be performed at the same time?

Your doctor will discuss with you whether any other procedure is required (such as repair of a prolapse) and if it could be carried out at the same time.

What are the benefits of TVT?

• shorter hospital stay (1-3 days) than other surgical treatments (4-6 days)
• small cuts – avoids opening up the abdomen
• can be done under local/regional anaesthetic

What are the risks?

• perforation of the bladder occurs more frequently with this procedure than with other standard surgical operations for stress incontinence - about 1 in 25 cases
• obturator nerve injuries – rare
• bowel perforations – rare would require bigger operation to repair
• vascular injuries – rare damage, and a longer stay in hospital

Are there any longer-term complications?

• inability to pass urine or difficulty passing urine – this may require the tape to be cut or removed
• erosion of the tape material into the bladder, urethra or vagina in approximately 1% of cases
• infection - rare

How effective is it?

Studies have shown the TVT procedure appears to have similar effectiveness to the main surgical alternatives and is associated with a shorter hospital stay. Not much is yet known about how effective tension-free vaginal tape is in the long term or whether there are likely to be any problems after the first few years.

Contact details

The Royal Oldham Hospital

Ward F5 Gynaecology Ward - 0161 656 1431/1432