Stress Urinary Incontinence
This is leakage of urine due to an increase in abdominal pressure, for example coughing or sneezing. It has to be distinguished from leakage of urine due to an abnormal bladder contraction (detrusor overactivity) and sometimes pressure studies of the bladder (urodynamics) have to be performed in order to clarify the diagnosis. This also helps ensure that the patient would be suitable for an operation for stress incontinence such as insertion of a suburethral tape (TVT).
TVT (Tension-free vaginal tape)
This operation involves inserting a tape under the middle part of the urethra. The tape can be made of different substances such as polypropylene and many urologists hesitated to put them in until long term data regarding their safety and complication rates were available.
It is now more than 10 years since they were first described and their long term safety and efficacy for at least that 10 year period is assured. The success rate of TVT is 85-90% in terms of achieving complete or near complete continence and that is comparable to the results obtained from colposuspension, a much more invasive procedure carried out through an open incision on the abdominal wall. So successful has TVT been in fact, that it has more or less superceded colposuspension which is now fairly rarely performed.
TVT – surgical technique
Under a general anaesthetic a small incision about 1.5 cm long is made in the roof of the vagina under the middle part of the urethra. A space just to each side of the urethra is made and the tape is fed up on each side in turn, passing the outside of the bladder and up to the bottom part of the abdominal wall. Two small incisions are made here for the tape to be brought through. It is very important to ensure that the tape is under no tension at all but loosely slings the urethra. Fitting it too tightly can cause complications. Regular cystoscopies (telescope inspections of the bladder) are carried out throughout the procedure to ensure that the tape is correctly sited. All 3 incisions are then closed with a dissolvable stitch. A catheter is not normally left in and patients go home either later the same day or the morning following surgery.