Patient Information. Tension Free Vaginal/ Obturator Tape (TVT) Royal Devon and Exeter NHS Foundation Trust

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1 Tension Free Vaginal/Obturator Tape (TVT) Royal Devon and Exeter NHS Foundation Trust Patient Information Tension Free Vaginal/ Obturator Tape (TVT) Reference Number: CW (version date: September 2016)

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3 TVT is a technique which has been designed to relieve the condition of urinary stress incontinence. The operation can normally be performed as a day case procedure and recovery is shorter than for previous incontinence operations. Common symptoms of stress incontinence are leakage of urine on coughing, sneezing, exercising and sudden movements which may develop into leakage on almost any walking, bending or lifting. Pelvic floor muscles are often very weak. The success rate of TVT is 85% in curing these symptoms but TVT is not a treatment for all types of incontinence. The TVT works by supporting the middle of the urethra where urine drains from the bladder to the outside. The traditional TVT is inserted through the vagina, and there will be two small incisions above the pubic bone below the bikini line, and the TVT is threaded into place with specially attached needles. In some cases, the tape is inserted through the vagina and two small incisions at the top of the thigh (obturator tape). The bladder is checked to make sure there is no bladder injury and once the position of the tape has been adjusted, the plastic sheath surrounding the tape is slipped off and the tape stays in place without being stitched. The vaginal and skin wounds are then closed. The operation was originally performed under a combination of local anaesthetic and sedation although a general or regional (spinal or epidural) anaesthetic can also be used

4 Surgery for incontinence should only be considered when: Conservative measures have been unsuccessful (e.g. eliminating infection and constipation, ensuring sensible drinking habits, pelvic floor physiotherapy. The incontinence has a significant effect on the quality of life. The woman is fit for surgery. Urodynamic testing confirms the diagnosis of stress incontinence. All surgery has a risk of complications, for TVT this includes: Bleeding, bruising, infection, perforation or damage to the bladder, difficulty passing urine after the operation and the development of new bladder symptoms such as urgency and urge incontinence. Catheters are used to keep the bladder empty if there is a problem passing urine post-operatively or if the bladder has been damaged by the tape and needles. Usually this is only for two or three days but occasionally for longer. Complications are more likely if the woman has had a lot of previous surgery with a scarred abdomen, or if the TVT is combined with another procedure such as prolapse repair. Other medical conditions such as heart disease, diabetes, bleeding disorders may also increase the risks of surgery. When an obturator tape is inserted, pain at the top of the thigh may be experienced for a few days after the operation. In a few cases the vagina fails to heal fully and the edge of the tape protrudes into the vagina. This can be corrected at a later date

5 Surgery will not be recommended if: The main problem is a different sort of incontinence, eg an overactive bladder as this condition can be made worse by surgery. If correct insertion of the tape would be too difficult, eg obesity, very narrow vagina, fixed hips. If future pregnancies are planned. Questions How long does the operation take? Usually between minutes. How will I feel when I return to the ward? After a short time in the recovery area of the operating theatre you are brought back to the ward to rest. You will feel sleepy but should not be in pain. You will want to go to the toilet to empty your bladder within a few hours and you may feel dizzy or uncomfortable at this point. Always ask for a nurse to be available to help. As the anaesthetic wears off you may feel quite sore around the area where the tape was inserted and may need simple pain relief. There is often some bleeding from the vagina. When can I go home? Most women can go home the same day. The nurses will check that you are emptying your bladder properly by using a small portable scanning machine. It is very important that you rest for the first week at home as the tape is not stitched into place; your body tissues grow into the mesh

6 When can I drive? Not for 1-2 weeks. You must be comfortable enough to do an emergency stop. When can I resume normal activities? Not for 1-2 weeks, but no heavy lifting for 6 weeks. When can I have sex? Not for 4-6 weeks to allow the vagina to heal. Rarely, a small piece of the mesh might be exposed in the vagina and may have to be trimmed if it causes discomfort. When can I go back to work? We recommend not for 4 weeks. When can I play sport? Allow 4-8 weeks to allow the mesh to really settle into place and the wounds to heal. What happens to the mesh? It remains in your body, supporting the urethra. What happens if it fails? This is more likely if you already have a co-existing bladder condition like an overactive bladder or if you are over 70 years of age. Fresh investigations and treatment would have to be considered. Occasionally a new tape may be inserted. Contact number In case of post-operative problems, please contact

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