TVT (Transvaginal Tapes) and Transobturator Tapes for Urinary Stress Incontinence - Benefits and Risks

• Introduction
• Abortion
• Amenorrhoea
• Birth Control
• Bladder Symptoms
• Cystitis
• Honeymoon Cystitis
• Urinary Tract Infection
• Frequency and Nocturia
• Urinary Incontinence
• Urge Incontinence
• Urodynamic Studies
• Bladder Training
• Oxybutinin
• Vesicare / Solfenacin
• Stress Incontinence
• Kegel Exercises
• TVT
• Overactive Bladder Syndrome
• Cancer in Women
• Childbirth
• Children and Teenagers
• Diet / Weight Loss
• Dysmenorrhoea
• Endometriosis
• Fibroids
• HRT
• Hirsutism
• Hysterectomy
• Infections
• Infertility
• Medication Drugs
• Menopause
• Menorrhagia
• Miscarriage
• Painful Sex
• Pap Smear Test
• PCOS
• Pelvic Pain
• PMS
• Postpartum
• Pregnancy
• Self Esteem
• Sexual Problems
• Vaginal Discharge
• Vaginal Prolapse
• Vulval Symptoms

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What surgical treatments are available for stress incontinence?

If the incontinence is thought to be related to prolapse, vaginal repair surgery (6) will improve the problem in about 80% of patients.

Some surgeons, particularly bladder specialists, may operate through the abdomen rather than the vagina. Stitches are introduced to either side of the urethra and attached to the ligaments or bone at the front of the pelvis (colposuspension).

Injections of inert substances can be introduced under the bladder neck. Although with training they are said to be simple to introduce, they are not quite so simple to remove should there be problems. If there is true incontinence associated with a hole in the system (fistula) aurologist (bladder specialist) is likely to be able to close this defect.

For many years a variety of meshes have been introduced under the urethra with varying degrees of success.

In the late 90s a simple technique - tension free vaginal tape (TVT) was introduced. A small incision is made under the urethra and the tape is inserted. Some surgeons perform the operation under local anaesthetic. Usually, you can go home the same day.

More recently, some urogynaecologists have placed the tape through the obturator foramen. Transobturator tape( TOT for short) is similar to an operation called tension-free vaginal tape (TVT). But the way the tape is put in and fitted is different in TOT. This may make TOT safer because there is less chance that your bowel or blood vessels will be injured. 

Success rates in the order of 85% have been quoted for TVT and TOT.⁰⁷⁰¹

In one study,⁰⁸⁰⁵ the risk ratio of repeat surgery was 2.6 (95% CI 0.9-9.3) times higher in the transobturator tape group compared to transvaginal tape. It was concluded that retropubic TVT is a more effective operation than the transobturator tape sling in women with urodynamic stress incontinence and intrinsic sphincter deficiency.

After 5, 7 and 10 years of follow up, success rates of 80% are reported.^{0803, 0804} TVT significantly improves the overall sex lives of women with stress urinary incontinence.

Sexual satisfaction seems to be improved by successful surgery for stress incontinence of urine. Orgasm incontinence, penetration incontinence, post-coital infections, anxiety, and avoidance of sex are all reduced.⁰⁸⁰²

Complications of Transvaginal tapes

Clinicians should receive specialized training for the transvaginal placement of mesh products and be vigilant for adverse events, the US Food and Drug Administration (FDA) warned on 20th October 2008 in a news release.

Though rare, complications associated with surgical mesh treatment of pelvic organ prolapse and stress urinary incontinence can have serious consequences. During the last 3 years, 9 surgical mesh manufacturers have submitted more than 1000 reports of complications that have included erosion through vaginal epithelium, infection, pain, urinary problems, and recurrence of prolapse and/or incontinence. ⁰⁸⁰¹

 

Related Medical Abstracts - Click on the paper title:-

• A prospective trial comparing tension-free vaginal tape and transobturator vaginal tape inside-out for the surgical treatment of female stress urinary incontinence: 1-year followup. (2007-01)
• Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape. (2007-02)
• Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. (2007-03)
• Assessment of TVT efficacy in the management of patients with genuine stress incontinence with the use of epidural vs intravenous anesthesia. (2007-04)
• A cost-effectiveness analysis of tension-free vaginal tape versus laparoscopic mesh colposuspension for primary female stress incontinence. (2006-01)
• Laparoscopic colposuspension and tension-free vaginal tape: a systematic review. (2006-02)
• Outcome of tension-free vaginal tape procedure when complicated by intraoperative cystotomy. (2006-03)
• Quality of life and continence 1 year after the tension-free vaginal tape operation.(2006-04)
• One-Year Follow-up of Tension-free Vaginal Tape (TVT) and Trans-obturator Suburethral Tape from Inside to Outside (TVT-O) for Surgical Treatment of Female Stress Urinary Incontinence: A Prospective Randomised Trial. (2006-05)
• Result of the tension-free vaginal tape in patients with concomitant prolapse surgery: a 2-year follow-up study. An analysis from the Netherlands TVT database. (2006-06)
• Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence. (2006-07)
• A randomized controlled e quivalence trial of short-term complications and efficacy of tension-free vaginal tape and suprapubic urethral support sling for treating stress incontinence. (2006-08)
• The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. (2006-09)
• A review of the tension-free vaginal tape procedure: outcomes, complications, and theories.(2001)

Please click on the required question.

• Q 29. 1  How is urine produced?
• Q 29. 2  What is cystitis?
• Q 29. 3  How prevalent is cystitis?
• Q 29. 4  What is honeymoon cystitis?
• Q 29. 5  What are Frequency and nocturia?
• Q 29. 6  How prevalent are Frequency and nocturia?
• Q 29. 7  What is urinary incontinence?
• Q 29. 8  What is stress incontinence of urine?
• Q 29. 9  What is urgency, urge incontinence and the urge syndrome?
• Q 29. 10 What causes stress and urge incontinence?
• Q 29. 11 What is dribbling incontinence?
• Q 29. 12 How prevalent is urinary incontinence?
• Q 29. 13 What is the urethral syndrome?
• Q 29. 14 How can I record my bladder problems and monitor the effects of treatment?
• Q 29. 15 What simple measures are available to reduce urinary incontinence?
• Q 29. 16 What are pelvic floor exercises?
• Q 29. 17 How successful are pelvic floor exercises?
• Q 29. 18 What is bladder training?
• Q 29. 19 How effective is bladder training?
• Q 29. 20 Are there any alternatives to bladder training for urgency symptoms?
• Q 29. 21 If simple measures do not suffice, what else is available for the treatment of urinary stress incontinence?
• Q 29. 22 What are urodynamic studies?
• Q 29. 23 Where can I obtain further information about bladder problems?
• Q 29. 24 Support Groups.