New York Urologic


Urinary Incontinence in Women- Sling Surgery

Stress incontinence is a common condition involving an involuntary loss of urine that occurs when a physical movement places pressure, or stress, on the bladder. Patients with this condition may experience a leakage of urine while coughing, sneezing, laughing, jogging or lifting something heavy. This condition usually occurs as a result of weakened sphincter and pelvic muscles that cannot adequately support the bladder and urethra. While stress incontinence can affect women of all ages, it is most common in women who are obese, post-menopause, or have had multiple pregnancies, as childbirth tends to stretch the urethral sphincter.

In many cases, stress incontinence is treated with a pubovaginal sling that is surgically inserted as a support for the urethra. A tension-free vaginal tape, or TVT sling is an advanced form of the traditional pubovaginal sling for the treatment of female stress incontinence. The TVT procedure is designed to create a support for a sunken or fallen urethra and eliminate the leakage of urine in women suffering from incontinence.

Benefits Of The TVT Procedure

TVT treatment is ideal for women with stress incontinence or intrinsic sphincter defects. The TVT sling is proven highly effective in the treatment of these conditions with long-term results. The TVT procedure is performed as an out-patient procedure and generally has a shorter recovery time than traditional pubic suspension surgery. It is important that women are healthy enough to undergo surgery and do not have any active infections.

The TVT Procedure

A local anesthetic is normally administered prior to the TVT procedure. During the procedure, two small vaginal incisions are made, into which a synthetic tape is inserted through the vagina and placed under the urethra as a permanent sling. The doctor then adjusts the tightness or tension of the tape just enough to support the urethra. After the tension is adjusted, the ends of the tape are cut and adjusted to the level of skin at the incisions. No sutures are used to hold the vaginal tape in place as scar tissue that forms at the incision sites will hold the tape in place. The TVT procedure usually takes 30 to 60 minutes to complete but the time may vary depending on the patient.

Risks Of The TVT Procedure

As with any type of surgical procedure, there are risks of the TVT procedure which may include:

  • Bleeding
  • Reaction to anesthesia
  • Infection
  • Damage to the urethra, bladder or vagina
  • Reaction to the synthetic tape
  • Tape erosion exposing the vagina
  • Inability to empty the bladder

Recovery From The TVT Procedure

After the TVT procedure, patients will usually be able to return home the same day, although an overnight stay may be required in some cases. Minimal pain and discomfort may be experienced and over the counter or prescribed pain killers may be used. Vaginal bleeding may also occur for a few days after the procedure. Most normal activities can be resumed in two to three weeks. However, patients should refrain from heavy lifting, strenuous activity, or sexual intercourse for at least six weeks.

The TVT procedure can effectively reduce occurrences of urinary incontinence by forcing the urethra to close during any kind of strain, such as laughing, coughing or other types of pressure on the bladder. Most patients experience a decrease in urinary leakage after the TVT procedure, however, in some cases, over time, urinary leakage may reoccur.