What Is It?

Tension free transvaginal tape (TVT sling) was first introduced in Sweden in the mid 1990's by Ulf Ulmsten and Papa Petros. The TVT sling is a technical advancement of a traditional operation known as a suburethral, pubourethral or pubovaginal sling. The literature supports the pubovaginal sling operation as one of the two most effective operations for the treatment of stress urine incontinence. The other most effective known operation noted in the literature is the Burch urethropexy. The TVT sling device is intended to be used as a pubourethral sling for treatment of female stress urinary incontinence (SUI) resulting from urethral hypermobility and/or intrinsic sphincter deficiency. So why is it considered a surgical advancement over traditional pubovaginal slings?

The TVT sling's main advantage is that a sling is placed, providing new support to failed native tissue, with less morbidity than traditional sling procedures. There is no need to harvest graft material. In other words, create another incisions to take a graft from another part of the body. Therefore... less incisions and needless to say less pain. Additionally, intraoperative assessment is possible via a cough test, as the procedure is performed under local, spinal or epidural anesthesia. The patient is actually asked to cough with a full bladder at the very end of the operation and when leakage occurs the TVT sling is gently adjusted to correct the leakage.

The TVT is a designer sling...a sling procedure that is adjusted for your individual needs. Most slings are indiscriminately pulled "tight" which may indeed correct the leakage...but may also cause the patient great difficulty with urination after the operation. This adjustment is individualized for each patient during the TVT operation thus dramatically reducing the chance the patient will need a catheter for any prolonged time period after the operation.

How Does It Work?

The GYNECARE TVT Tension-free support for incontinence primarily consists of a mesh-like tape that is surgically inserted through the vagina to support the bladder neck and urethra, the tube through which urine exists the bladder. Ordinarily, the urethra maintains a tight seal to prevent involuntary loss of urine. For women with stress urinary incontinence, a weakened pelvic muscle floor or a defect in the urethral fascia cannot support the urethra in its correct position. If you undergo TVT surgery, your surgeon will restore the normal position of the urethra by weaving or placing a "sling" or mesh tape beneath it. Uniquely, TVT provides support at the middle of the urethra, the section that is under the most strain during normal activities. Placing the TVT in this area, therefore, helps restore this part of the urethra---instrumental to the urination process-- to a more natural position. Unlike other procedures, no bone anchors or sutures are necessary.

How Does the TVT System Alleviate Stress Urinary Incontinence?

Female SUI is caused by an improperly functioning urethra. Unlike other types of incontinence, SUI 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. When a woman suffers from the most common form of stress urinary incontinence, however, weakened muscle and pelvic tissues are unable to adequately support the urethra in its correct position. As a result, during normal movement as pressure is exerted on the bladder from the diaphragm, the urethra cannot retain its seal, permitting urine to escape.

The TVT system combines the use of a safe material, PROLENE™ polypropylene mesh tape, with a traditional surgical procedure known as the sling, to correct SUI. The mesh is positioned underneath the urethra, creating a supportive sling. When pressure is exerted, such as during a cough or sneeze, the tape provides the support needed by the urethra, allowing it to keep its seal.

Call us today for an appointment.