TVT (tension-free vaginal tape) and TOT (transobturator tape)
Transvaginal tape-obturator is a safe and simple prosthetic device for female stress urinary incontinence. The device is a ribbon of tape or mesh that can be placed in the walls of the urethra from where the urine leaks. The mesh of the device is made up of polypropylene, a synthetic material. The mesh grows into the soft body tissues to reinforce the weakened tissues of the urinary bladder. The device closes the urethra and keeps it closed when the patient strains, laughs, coughs or puts pressure on the bladder. It is a simple procedure that is usually performed on an out-patient basis with a fast recovery.
The treatment is beneficial for women who have stress incontinence along with leaking of urine due to certain activities such as coughing, sneezing, laughing, lifting or walking or playing sports. It is not recommended for women who may or wish to become pregnant.
The implantation of transvaginal tape takes about 40 minutes and is usually performed under general anaesthesia or spinal with sedation. The procedure begins with an incision in the vagina just beneath the urethra opening. The mesh tape is inserted through the incision in the vagina and positioned underneath the urethra. The tape is then pulled through two tiny incisions in the skin surface, just above the pubic area. The tape lies completely tension-free under the urethra like a hammock and supports the bladder during straining. The friction between the underlying tissues of the pelvic area and the tape holds the implant like velcro. Gradually the body tissues grow into the mesh and permanently secure the device. At the end of the procedure the surgeon may trim the tape and will then close the incisions.
Risks and Complications
The associated post-operative risks and complications include post-operative voiding problems such as urinary retention due to implantation of the TVT too tightly to the urethra, bleeding during or after the operation, mild bladder infection or cystitis, urinary urgency or incontinence and urinary tract infection. Sometimes erosion of the tape into the bladder or vagina can occur in spite of appropriate positioning of the implant and this may cause haematuria or other urinary symptoms, pelvic pain, discharge and dyspareunia (painful intercourse).
A pubovaginal sling is a surgical procedure to correct urinary incontinence in women. When other medications and less-invasive physical treatments are unsuccessful to relieve the symptoms, surgery may be recommended. The procedure involves grafting a sheet of tissue to the lower end of the bladder to provide extra support to the base of the urethra. The sling has proven highly beneficial and most women experience full recovery within about one month.
Stress urinary incontinence is a very common problem among older women that occurs due to weakness of urethral muscles with age. Weakness of the urethral muscles leads to accidental leakage of urine due to increased pressure inside the abdomen, such as from coughing, laughing, or sneezing. Women who have given birth or engage in strenuous physical activity are more predisposed to incontinence issues.
A pubovaginal sling is made up of abdominal fascia tissue and is also known as autologous sling. When any pressure from coughing or running pushes down the bladder and urethra, the pubovaginal sling provides resistance. The sling maintains the urethral opening tight under pressure and prevents urine leakage.
The procedure is usually performed under general anaesthesia. A small incision may be done just above the pubic bone to provide access to the bladder neck for surgery. The sling may be inserted into the vagina and placed underneath the urethra and bladder neck. The surgeon employs small instruments to suture the two ends of the sling to the lower abdominal tissue on either side of the bladder. The implanted sling provides support to the bladder neck and controls the incontinence. After the surgery two to three days of hospitalization may be required to monitor the recovery and assess for any complications. After discharge the patient is instructed to avoid physical activity for several days and return for a check-up in about one week. A successful treatment ensures quick healing and allows the patient to return to normal activities within a month on average.
The associated complications of the pubovaginal sling implant include post- surgical haemorrhage, urethral obstruction from tying the sling too tightly which may lead to urinary retention. Sometimes recurrence of stress urinary incontinence, urge incontinence or urinary retention also may occur.