Tension-Free Vaginal Tape (TVT) Sling for Stress Urinary Incontinence
Dr. Miklos learned the TVT sling procedure in Stockholm, Sweden in 1998. The TVT sling procedure has been performed in Europe since 1995 with great success. Dr. Miklos was the first of four surgeons in the United States to perform the TVT sling operation and served as a preceptor to teach this operation to Urologists, Urogynecologists and Gynecologists throughout the world. In June 2000, Dr. Miklos traveled to Russia to introduce the TVT sling operation to his colleagues at the University of Moscow.
Both Drs. Miklos and Moore choose the TVT sling for their patients because the operation is/has:
- Minimally invasive (two incisions of 1/3 inch on the pubic hairline)
- Minimal pain (40% of patients will not need a pain reliever after 24 hours)
- Proven cure rate of 80-90% – 5-10 years after surgery
- Same day or next day discharge for 98% of patients
- Performed under local anesthesia and IV sedation
- Operative time 20-30 minutes
- Minimal postoperative need for catheterization
- Minimal complications
How Does TVT Sling 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 TVT sling tape provides the support needed by the urethra, allowing it to keep its seal.
Are you a candidate for TVT Sling Procedure?
The best way to determine if you are a candidate for the TVT sling procedure is to consult your doctor. The TVT sling procedure is appropriate for many types of patients, including overweight women and patients who have previously undergone other operations for incontinence. However experience on the part of the surgeon is especially necessary if the patient has undergone other operations in the past for incontinence. The blind retropubic passage of the TVT sling device can be much more difficult in patients with previous incontinence surgery due to the severe amount of scarring which occurs after such type of incontinence surgery.
For whom is the TVT sling procedure not recommended?
As with any surgery of this kind, the TVTsling procedure should not be performed in pregnant patients. Additionally, because the mesh-like tape will not stretch significantly, the TVT sling procedure should not be used in women who plan future pregnancy.