Patient Information Leaflet MID-URETHRAL SLING OPERATION TENSION-FREE VAGINAL TAPE (TVT) TRANSOBTURATOR TAPE (TOT, TVT-O)
This information leaflet has been developed to help your understanding of what is involved with a TVT / TOT / TVT-O. It is intended to be a guide and is not expected to cover every possible detail. What is Stress Urinary Incontinence (SUI)? Stress urinary incontinence is a condition in which you leak urine on exertion e.g.: when you cough, sneeze, jump, run or perform exercises. What is mid-urethral tape operation? It is an operation that is performed for SUI. It works by placing a tape through a vaginal incision to support the middle of urethra (pipe from bladder from which urine comes out). There are mainly 2 types of tapes that could be used for the operation. TVT differs from a TOT / TVT-O in that two further skin cuts are made in lower part of your tummy in the pubic hair area whereas TOT / TVT-O may need two further cuts in the groin (inner side of the upper thigh). There are no major differences in outcome but the doctor may prefer one technique over the other when indicated. Success Rate Improvement in the frequency and amount of leaking episodes after the procedure is noted in 82-96% of women after the procedure (National Institute of Clinical Excellence - patient information 2005). Long term success rate is nearly the same over the following 10 years. Surgical procedures for stress incontinence are best deferred if you plan to have children or think you might want to in the future. The pre-operative visit Before your visit, we will invite you to a pre-operative clinic where you will be assessed for surgery. You will be seen by a member of the nursing staff who will ask questions about your previous medical history and will arrange for some blood test. You will also be told if you need to stop taking your medications or not on the day of the operation. 2
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What happens before the operation? If your operation is in the morning, you must have nothing to eat or drink after midnight. If you are having your operation in the afternoon, you may have a light breakfast and a drink no later than 6 am. The breakfast can consist of cereal and toast; you must not have a large cooked meal as this could affect you during the operation. Please leave any jewellery at home. If you are unable to remove any piece of jewellery, a protective tape will be placed over it. When you arrive on the ward, the nurse will check your details and will show you to your bed and help you to change into a gown and give you an identity wristband. It you are wearing any nail varnish or make up you will be asked to remove it. We will take some basic tests such as pulse, temperature, blood pressure and a urine sample. You will also need to remove contact lenses, glasses and false teeth. Visit by the surgical team A doctor will come and see you and explain the operation to you and ensure that you do not have any further questions. If you have already signed a consent form in the clinic, please bring it with you. If you have not signed one, we will ask you to sign one that gives us permission to perform the operation. Visit by the anaesthetic team One of the anaesthetists who will be giving you your anaesthetic (general or spinal) will come and see you. Please tell the anaesthetist about any allergies, chest problems, dental treatment and any previous anaesthetics you have had, and also any anaesthetic problems within the family. TVT will need to be performed while you are awake but either drowsy of under regional / spinal anaesthesia as you will need to cough strongly few times during the procedure and the tape is specially adjusted to the leakage. Please bring into hospital any tablets or medicines you may be taking. 4
How long does the operation take? The operation usually takes about thirty minutes. However, you will stay in recovery for monitoring after the operation. What happens after the operation? After the operation you will be taken to the recovery room. You may find you have a mask supplying oxygen and a narrow tube into your vein to give you fluids. A catheter is sometime left to drain your bladder until you are able to walk to the toilets. A mid-urethral sling operation can be done as a day case operation so you may be able to go home on the same day or you may need to stay in hospital overnight if the operation is done in the afternoon. Most women need to stay in hospital for 1 to 2 days until we are sure that they are passing urine without difficulties. If you have problems passing urine, you may need to have a catheter for a few days or be taught how to empty your bladder yourself with a catheter. Dissolvable stitches or glue may be used for the cuts and usually will not need to be removed. You may notice a stitch coming away after a few days or you may also get some vaginal discharge. What are the risks associated with this procedure? Complications are not common and include: Haemorrhage (excessive bleeding) Infection 1% 1-5% risk of bladder perforations. If this occurs you will have a catheter inserted and be left for 10 days. We may send you home with the catheter and make an appointment for you to come to the clinic to have the catheter removed. 5% experience difficulty in emptying their bladder. If this occurs you will be sent home with a catheter and an appointment will be made to have the catheter removed or you will be taught self catheterisation and reviewed regularly. 5-10% of women develop the urge to pass urine and frequency after the procedure. Less commonly they can develop urge incontinence. If you have pre-existing urgency or urge incontinence, this could get worse. 6% of women experience urinary tract infections after the procedure and this can be treated with antibiotics. If you develop difficulty in passing urine, or severe urgency that does not respond to drug therapy, the tape may need to be divided. Other rare complications including tape erosion or rejected, bowel, vessel injury, clots in the leg or pain in the thigh. Rarely the tape might erode into the urethra.
How long will I be in the hospital? You will be able to go home after you pass urine several times. You should have eaten before you go and had a walk in the department. You must arrange for an adult to take you home in a private car or taxi. You will not be able to travel on a public transport, as it will be too painful and uncomfortable. You will be slightly drowsy for one or more days after the procedure and you should not drive during that time and your judgement might be impaired. If you have had additional surgery, you may need to stay in for few more days depending on type of surgery and your recovery. What are the benefits of this treatment compared with other procedures for SUI? The benefits of this treatment are: Relatively small procedure with a quicker recovery little post operative pain you will be able to return to normal activities and work sooner no large cuts on your tummy long term benefits are comparable TVT / TOT can also be combined with prolapse surgery in which case the recovery may be longer. Are there any alternatives to TVT / TOT? Pelvic floor exercises are usually the first step in managing mild symptoms of SUI. They can also be effective in preventing incontinence from worsening. The exercises have to be performed daily and a cure rate of up to 70% may be expected in mild SUI. If exercises do not work or cannot be done, surgery will be the next option. Conventional major surgery (colposuspension) it is done through a larger cut on your tummy. It may achieve a better short term success rate with comparable long term success rate, but there is usually a four to six day stay in hospital and you will need to take six weeks off work. To inject a bulking agent around the bladder neck. This procedure may be 65% successful at first, but can become less effective (20%) with time and you may have to have the procedure repeated in nine months to one year. How will the operation affect my sex life? In the long term there is no evidence that the operation will make any difference to your sex life. However if you previously leaked urine during intercourse, the operation often makes this better. 6
Activities to avoid You should avoid: Sexual intercourse or using tampons for 4-6 weeks Constipation/heavy weight lifting to avoid recurrence Wight gain Smoking Douching of the vagina Any persistent cough needs to be treated promptly When can I resume work? Usually within 2 weeks. However if there are ongoing problems contact your GP who will consider an extension of your sick leave. When will I be seen again? We will hand you questionnaire similar to the one you filled before the surgery in pre paid envelope, please answer the questionnaire two months after the surgery and send it back to us, we will read it and decide if you need further follow up in the clinic. What if I have problems after discharge? If you are unable to pass urine after discharge or have severe vaginal bleeding, abdominal distension or pain you need to attend the Accident and Emergency Department (A and E) immediately. Contact your GP if you have other problems such as: High fever Pain when passing urine or blood in the urine Difficulty opening your bowels Pain or swelling of the legs Your questions and comments If you have a problem when in hospital that the nurses and doctors are unable to resolve, you can contact the Patient Advice and Liaison Service (PALS) who will be happy to help you. PALS offers assistance, advice and support for patients and their families. The service can help if you have concerns or worries about treatment or care. PALS may also be able to provide further information about tests and procedures. They also have a library of voluntary and support agencies. You can talk to the team by phoning 01438 284678 or emailing pals.enhtr@nhs.net Smoking Lister is a no smoking hospital. If you would like help to stop smoking before you come into the hospital, there is a smoking cessation help. For more information, call the NHS Stop Smoking helpline on 0800 022 4332. Visitors must not smoke at all in the hospital or in hospital grounds. 7
Any Further Questions? If you are worried about having the operation or have any questions please contact the gynaecology ward at the: Lister Hospital, Ward 7A South 01438 286193 www.enherts-tr.nhs.uk Date of publication: September 2015 Author: AD/RA Review RS Reference: TVT/TOT Version: 2 Review Date: September 2018 East and North Hertfordshire NHS Trust You can request this information in a different format or another language.