TVT / TVT-O Continence Surgery

What Is TVT / TVT-O Continence Surgery?

TVT stands for Tension-free Vaginal Tape which is made of prolene. It has become the new "gold standard" operation for treating women with stress urinary incontinence. The result at 5 years is 85% cure, 10% improved and 5% failure. It was introduced in Sweden in 1995. The first operation in Singapore was performed at our hospital in November 1998. A newer version of the procedure, TVT-O (tension-free vaginal tape-obturator) was introduced in May 2004 in our hospital. It is equally good in curing stress urinary incontinence.

What Are The Advantages Of TVT / TVT-O Continence Surgery?

Both the TVT & TVT-O continence surgery takes between 10 to 15 minutes to perform. It can be done under regional or general anaesthesia. It can be done as a day surgery so that you may go home on the same day. The post-operative pain and the risks of surgery are less as compared to Burch Colposuspension - another well-established continence surgery. As with any continence surgery, it is advisable for a patient who has not completed her family to do so before having the TVT/TVT-O surgery so as to reduce the risk of failure.

What Are The Risks Associated With TVT / TVT-O Continence Surgery?

The TVT / TVT-O continence surgery is generally a safe procedure. However, like all surgeries, complications may occur occasionally. These include:

• Risk of anaesthesia
• Bleeding
• Infection
• Injury to surrounding tissues (e.g. bladder, rectum and blood vessels)
• Formation of blood clot in the legs or lungs
• Rejection of tape - As the tape is a synthetic tape which will be left permanently in the body, rejection may occur.

What Are The Bladder Specific Complications In TVT / TVT-O Surgery?

As with other continence surgeries, there are certain bladder specific complications which may arise from TVT surgery:

• Injury to bladder for TVT; the risk is much lesser for the TVT-O surgery
• Need to go to the toilet frequently
• The urge to void
• Incontinence due to urgency
• Slow urine flow
• Inability to void completely necessitating prolonged catheterisation or intermittent self catheterisation
• Failure

What You Need To Do Prior To Surgery

1. Blood tests, heart tracing (ECG) and chest X-ray may be done to ensure that you are in optimal health.
2. You may be given oral or vaginal oestrogen (hormone) if you are near or already menopausal. It is important to comply with this medication as it thickens your vaginal tissues for easy surgery and faster healing.
3. All your medications and medical conditions, if any, must be made known to the doctor and must be optimally controlled.
4. If you are on aspirin, please let us know. You have to stop taking it a week prior to the surgery.
5. You will not be allowed to eat or drink after midnight on the day before surgery.
6. You may be admitted on the same morning of surgery or a day before surgery.
7. You will be given preparation to clear your bowels and have the pubic area shaved.

What You Can Expect In The Operating Theatre

The TVT / TVT-O continence surgery is usually done under regional or general anaesthesia (i.e. where you will be asleep throughout the operation). You may discuss it with the anaesthetist.

The TVT operation involves two small incisions of 0.5 cm each on your lower abdomen below your pubic hairline and a 1.5 cm incision on your anterior vaginal skin. The TVT tape is inserted below your urethra into the abdominal wound. The operation takes about 15 minutes. At the end of the surgery, a urinary catheter may be inserted into your bladder to allow free urine flow. A vaginal pack may be inserted as well.

The TVT-O tape is inserted through the same 1.5 cm anterior vaginal wall incision; but has two 0.5 cm incisions in the groin area instead.

What Happens After The Operation?

1. After the operation, you may experience:
   • Nausea and occasional vomiting - You should rest and medication will be given to relieve these symptoms.
   • Pain from the wound - This is usually mild and you will be given painkillers.
   • Post-operative care - You should rest and gradually increase your movement. The physiotherapist can help if necessary.
2. If you are given regional anaesthesia, a 6-hour bed rest is recommended before you are allowed to get out of bed. After that, you are encouraged to move around.
3. You will be allowed to drink and eat on the same day of operation.
4. The vaginal pack, if any, will be removed the next day.
5. The urinary catheter, if any, will be removed later on the same day or on the next day. You will be encouraged to void on your own. The volume of the remaining urine will be measured. If you can void adequately, you will be allowed to go home. 6. You are advised not to engage in sexual activity, drive or douch your vagina for a month after surgery.
6. You are advised not to carry heavy weights (of more than 5 kg) in the long run after surgery.
7. You will be given one month's hospitalisation leave.
8. You should return immediately to the Urogynaecology Centre (during office hours) or the Urgent O&G Centre if you have:
   • Severe vaginal bleeding
   • Severe abdominal distension or pain
   • Foul smelling discharge from the wound
   • High fever
   • Pain when passing urine
   • Difficulty in passing urine or motion
   • Pain or swelling of the calves

Follow-Up Visits

After the surgery, you will be seen at 1 week, 1 month, 6 months and yearly intervals thereafter. Urodynamic studies will be repeated at 6 months after surgery to confirm cure and to exclude other bladder disorders.