Tension-Free Vaginal Tape and TVT-O

Tension Free Vaginal Tape (TVT) & Obturator Technique TVT-O

The Tension Free Vaginal Tape (TVT) and related procedures are for the management of stress urinary incontinence. Originally developed in Sweden around 1995, it  rapidly became a gold standard procedure for the treatment of stress incontinence.

Long term studies show the 5-7year success rate to be equivalent to traditional procedures. Importantly, the success rates appear to be maintained over time. With its low morbidity, the TVT and TVT-O procedures have become the new primary procedure for the management of Genuine Stress Incontinence.

In August 1999, Prof. Nilsson (Finland) toured Australia teaching this technique in selected hospitals. North West Brisbane Private was fortunate to be the first stop on this teaching tour and he and I performed 4 cases at that time.  (see Australian Doctor 17th March 2000)

I have now performed hundreds of the TVT operations and have a 90% success rate (NOT 100%). I advise women that while no procedure is 100% successful, 8-9 out of 10 are cured or have an 80-90% improvement. If you leak a lot, it is easy to demonstrate this improvement. If you only leak a drop occasionally then you may still achieve this result but it is very hard to demonstrate. This procedure involves minimal trauma and much lower complication rates than traditional surgery. There is usually only a minor interruption to normal activities but the usual 'no heavy lifting' applies. You can drive a car in 3 days (assuming you could drive to start with).

The procedure involves placement of a prolene mesh tape around the mid-urethra with the ends of the tape passing upwards behind the pubic bone. The tape places no tension on the urethra because there is a gap between the tape and the urethra. The serrated edge of the tape grips the para-urethral tissues and allows the tape to remain firmly in place without suturing. The tape is placed under a spinal anaesthetic and utilises 3 small incisions. Although you doze through most of the operation, you are awake for the final adjustment. At this time your bladder is filled with sterile saline and you are asked to cough. The surgeon then makes the necessary final changes to gain continence.  The entire operation takes about 30 minutes and there is minimal discomfort.
Originally designed as a 'day case' procedure, I tend to keep women overnight as occasionally they require pain relief or have difficulty voiding due to swelling.
Cost is always an issue, but fortunately the device (prolene mesh tape - 1cm wide, with needles attached at each end) is only $700 and fully rebateable from Private Health Funds.
For the uninsured patient this is still cost effective when compared with at least 5 days ($220 per day intermediate) in hospital for a traditional Colposuspension (Bladder Neck Suspension), assuming there are no problems.
The TVT-O procedure represents the next evolution of the TVT operation. It is almost identical except that the tape extends from groin to groin and so does not pass behind the pubic bone. It has a lower rate of voiding problems but may not be suitable for all patients.
Urodynamics is an important investigation prior to undergoing surgery, which helps to determine which operation you need and what potential problems you may run into when recovering from a continence operation.  

Risks & Complications