Transvaginal Tape (TVT)

What is Transvaginal Tape?

Transvaginal Tape is a minimally invasive procedure for women who suffer from stress urinary incontinence (involuntary leakage of urine when coughing, sneezing, laughing, jumping, walking, sitting, or standing). In Transvaginal Tape, the urinary bladder and urethra are repaired, strengthened and returned to it's original position in the pelvis.

Where can I get Transvaginal Tape?

Country	Cost with MedSolution
India	(Please inquire for price)

All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.

What is Stress Urinary Incontinence?

Stress Urinary Incontinence or Stress Incontinence is a problem of the urinary bladder where the urethral sphincter weakens and as a result, cannot prevent the flow of urine through it when the intra-abdominal pressure rises such as in coughing, sneezing, lifting something heavy or even standing or walking. There are several causes of urethral sphincter weakness, most common being advancing age, multiple un-assisted child births, smoking, obesity and chronic coughing such as chronic bronchitis and asthma. Stress Urinary Incontinence is usually associated with Cystocele where the urinary bladder sags into or even outside the vagina

Who is an ideal candidate for Transvaginal Tape?

If you are a woman suffering from Stress Urinary Incontinence (due to any of the above reasons) and do not plan on getting pregnant any more, then you are an ideal candidate for Transvaginal Tape surgery.

What are the variants of Transvaginal Tape?

• Marshall Marchetti Krantz (MMK) - This procedure is performed through an abdominal incision. Sutures are placed on either side of the urethra and neck of urinary bladder so that it is elevated to a higher position. The free ends of the sutures are anchored to the pubic bone and the surrounding cartilage.
• Transobturator Sling - In this procedure, a sling is placed through an incision in the vagina thus restoring the anatomy of urethra and urinary bladder
• Burch Procedure - This procedure is usually performed in combination with other procedures requiring abdominal approach e.g. abdominal hysterectomy. In Burch procedure, the vaginal wall is lifted and sutured to tissues near the pubic bone. This strengthens and stabilizes the urinary bladder and prevents leakage of urine during activities that might increase the intra-abdominal pressure such as lifting something heavy, coughing or sneezing.
• Pubovaginal Sling - In this procedure, a sling will be made from your own fascia (fibrous tissue), will be adjusted around the bladder neck and will be stitched to it by 2 sutures to support the bladder neck.
• Adjustable Suburethral Sling - In this adjustable transvaginal midurethral synthetic sling procedure, a sling is attached to sutures that are taken through a tensioning device placed above the tissues in the suprapubic region.
• Transobturator Tape (TOT) - A synthetic mesh tape is placed under the urethra. This tape supports the urethra in times of stress, such as coughing, sneezing, laughing, jumping. This procedure may be performed under general, regional (spinal or epidural) or local anesthesia and requires three tiny incisions: one, one-inch vaginal (under the urethral opening) and two, one-fifth inch perineal incisions. TOT is an outpatient procedure that takes 20 to 30 minutes, requires only few days of recovery to go back to light duty (office) work and about two weeks for all other activities.
• Tension Free Transvaginal Tape - This is the newest technique performed to treat Stress Urinary Incontinence. In Tension Free Transvaginal Tape procedure, a mesh-like tape is inserted through a incision in the vagina to support the bladder neck and urethra and compress the urethra closed during activities that raise the intra-abdominal pressure such as laughing, sneezing, coughing or lifting something heavy. Tension Free Transvaginal Tape is an outpatient procedure that takes 20 - 30 minutes, requires only few days of recovery to go back to light duty (office) work and about two weeks for all other activities.

How do I prepare for Transvaginal Tape procedure?

Transvaginal Tape is performed on an out-patient basis therefore, prior hospitalization is not necessary. Ask your doctor about any special instructions to prepare for Transvaginal Tape. Since all medical procedure have a small risk of injury, e.g. injury to ureter or rectum, you will need to sign a consent form before the test. Do not hesitate to ask your doctor about any concerns you might have. You may be asked to give a urine sample before the test to check for infection. Inform your physician about your other health conditions and medications (including all the prescription, non-prescription medications, nutritional supplements i.e. vitamins, minerals and herbal products). Refrain from taking aspirin or Ibuprofen at least 2 weeks before the Transvaginal Tape. Stop smoking a few weeks before the operation to prevent healing problems during recovery period. Do not eat or drink anything for at least 10 hours before the the Transvaginal Tape procedure. You will wear a hospital gown for the examination, and the lower part of your body will be covered with a sterile drape. In most cases, you will lie on your back with your knees raised and apart. The procedure will be performed under general anesthesia and you will be hospitalized for 3 - 4 days (for transabdominal approach) or 1 - 2 days (for transvaginal approach) for Transvaginal Tape. A nurse or technician will clean the area around your urethral and vaginal opening and apply a local anesthetic.

What does the procedure for Transvaginal Tape involve?

Transvaginal Tape is a minimally invasive procedure to treat Stress Urinary Incontinence in women. Transvaginal Tape procedure may take about 30 - 40 minutes and is usually performed under local anesthesia with sedation. A mesh tape is inserted through a small incision in the vagina and is positioned underneath the urethra. The Transvaginal Tape is then pulled up through two tiny incisions in the skin's surface just above the pubic area. As it passes through several pelvic tissue layers, the friction of underlying tissues holds the tape in place like velcro. Over time your body tissues will grow into the mesh and will permanently secure it. The surgeon will ask you to cough so that any necessary adjustments can be made right then and there. At the end of the procedure the Transvaginal Tape will be trimmed just under the skin's surface and the tiny incisions will be closed.

What to expect during the recovery period following Transvaginal Tape procedure?

After the Transvaginal Tape surgery, you will spend the next couple of hours under observation for any immediate post-operative complications like bleeding or urinary retention. You will be able to go home the same evening or the next day following Transvaginal Tape surgery. You will be able to return back to your daily activities within 2 - 5 days and recover completely within a 2 - 3 week period. During this time there should be very little interference with daily activities, although you will have to avoid heavy lifting, strenuous exercise and sexual intercourse for four to six weeks. You will recover completely within 2 - 3 weeks. During this time, avoid heavy lifting, strenuous exercise and sexual intercourse for 4 - 6 weeks.

What is the outcome of Transvaginal Tape?

Millions of women around the world suffer from Stress Urinary Continence and Transvaginal Tape is a popular procedure which is performed to treat this problem. The 5 year success rate of Transvaginal Tape is 85 - 90%. A small percentage of women need a revision procedure.

B . R . A . N . D . of Transvaginal Tape

Benefits of Transvaginal Tape

• In addition to the medical benefit from Transvaginal Tape, you will also experience a profound effect on the your emotional well-being. The offensiveness from Stress Urinary Incontinence can result in social alienation, ostrasization and and immense emotional trauma. Transvaginal Tape can help you once again become part of the mainstream population and you will be able to socialize with confidence and without any fear of rejection.

Risks of Transvaginal Tape

• Transient Vesicoureteral reflux and spasm of urinary bladder
• Recurrence of problem
• Urethral / Ureteral Stricture
• Infection
• Excessive bleeding
• Injury to other organs e.g. ureter, urinary bladder
• Thrombo-embolism

Alternatives to Transvaginal Tape

• Medications
  • Pseudophedrine hydrochloride
  • Alpha-adrenergic agonists e.g. ephedrine, epinephrine and norepinephrine
  • Hormone replacement therapy
• Non-surgical options
  • Kegel exercises - These exercises strengthen the pelvic floor muscles to improve bladder control.
  • Biofeedback is practiced with Kegel exercise to reinforce proper technique. You will visualize and identify the pelvic floor and abdominal muscles that are contracted during exercise.
  • Neuromuscular Electrical Stimulation (NMES) - This technique is used to retrain and strengthen weak muscles and improve bladder control. Electrical stimulation of the pudendal nerve causes pelvic floor and urethral sphincter muscles to contract. A probe will be inserted into the vagina and a current is passed through the probe at a level below the pain threshold, causing a contraction. You will be instructed to squeeze the muscles when the current is on. After the contraction, the current is switched off for 5 - 10 seconds. Each treatment session lasts approximately 20 - 30 minutes.
  • NeoControl - This is modification of Kegel exercises using magnetic impulses. The magnetic pulses are aimed at the pelvic floor muscles through the seat of the chair, the muscles contract and relax with each magnetic pulse, much like Kegel exercise. It takes about 8 weeks of therapy to achieve positive results.
• Injectable implants - Injectable implants are material that are used to increase the bulk around the urethra. This can improve the function of the urethral sphincter and compresses the urethra near the bladder outlet. Most commonly used injectables include collagen (naturally occurring protein found in skin, bone and connective tissue), fat from the patient's body (autologous fat), and polytetrafluoroethylene (PTFE) and Durasphere (synthetic compounds).

Now or Never

• You may find that your Stress Urinary Incontinence is not improving with exercise, medications or behavior modification. To deal with your symptoms, Transvaginal Tape may be your best option. The goal of Transvaginal Tape surgery is to cure the cause of the urinary incontinence, either by supporting the bladder and urethra in its proper position or by tightening the sphincter muscles.

Decision to have Transvaginal Tape

• Stress Urinary Incontinence is a common problem among women, so you are not alone. The good news is that it is treatable so you do not have to suffer quietly, let it interfere with your activities and allow your quality of life to deteriorate. Help is just a phone call away! Most of the variants of Transvaginal Tape procedures can be used to achieve successful results.