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TVT - Tension Free Transvaginal Sling
Tension free vaginal tape (also known as TVT) was first introduced in Sweden in the mid 1990's by Ulf Ulmsten and Papa Petros. To date more than 150,000 patients worldwide (35,000 in U.S.) have been treated with GYNECARE TVT Tension-free support for incontinence. The majority of clinical studies suggest cure rates between 85-95%, most patients notice immediate improvement.
Dr. Miklos traveled to Sweden in October 1998, learned the operation and was the first surgeon in the Southeastern United States to perform the surgical procedure. Since that time approximately 200 surgeons have traveled to Atlanta to learn the surgical procedure from Dr Miklos. In October 2000 he was awarded the Golden Laparoscope Award at the 30th Annual American Association of Gynecologic Laparoscopists for his teaching video on the Tension free Transvaginal Tape procedure. To date he has performed almost 250 TVT operations and remains a national consultant and expert in its use.
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TVT Transvaginal Tape Sling |
- Simple 30 Minute Operation
- Two Miniature 1/3 Inch Incisions
- Outpatient Procedure
- Requiring Local Anesthesia
- 86 - 95% Cure Rate
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How Does It Work?
The GYNECARE TVT Tension-free support for incontinence primarily consists of a mesh-like tape that is surgically inserted through the vagina to support the bladder neck and urethra, the tube through which urine exists the bladder. Ordinarily, the urethra maintains a tight seal to prevent involuntary loss of urine. For women with stress urinary incontinence, a weakened pelvic muscle floor or a defect in the urethral fascia cannot support the urethra in its correct position. If you undergo TVT surgery, your surgeon will restore the normal position of the urethra by weaving or placing a "sling" or mesh tape beneath it. Uniquely, TVT provides support at the middle of the urethra, the section that is under the most strain during normal activities. Placing the TVT in this area, therefore, helps restore this part
of the urethra---instrumental to the urination process-- to a more natural position. Unlike other procedures, no bone anchors or sutures are necessary.
Patients deserve the most
trusted and experienced care
Surgery
Surgery using the GYNECARE TVT usually takes approximately 20-30 minutes. While it can be performed under general anesthesia most of the studies performed recommend local or regional anesthesia (ie epidural or spinal). Many surgeons like Dr. Miklos has performed most his 200+ operations under local anesthesia with some intravenous sedation. Under local anesthesia the patient will be semi-awake, but will not feel the surgery. This allows the
surgeon to evaluate whether the tape is providing adequate support by asking you to cough. Any
necessary adjustments can be made right then and there. So, even before you leave the
operating the room, the surgeon can usually determine if the procedure is successful.
Performing this evaluation be fore the procedure is complete also reduces the need for using a urinary catheter, unlike other sling operations. Patients report minimal discomfort following surgery with the TVT for incontinence. In fact approximately 40% of Dr.
Miklos' patients will not use any pain medication after being discharged from the hospital.
Surgical Technique
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| 1 - Paraurethral dissection is performed
after an initial midline incision on the anterior
vaginal mucosa at the level of the midurethra. Note the small
suprapubic abdominal incisions bilaterally. |
2 - After bilateral dissection of the
paraurethral space, the rigid catheter
guide is inserted into the urinary catheter. The handle of the
guide is deflected to the ipsilateral side and the needle is
inserted into the paraurethral space. |
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| 3 - The tip of the needle is angulated laterally and the endopelvic fascia is perforated just behind the inferior surface of the pubic symphysis. |
4 - After perforation of the endopelvic fascia, the tip of the needle is guided through the retropubic space along the backside of the pubic symphysis. |
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| 5 - After perforation of the rectus fascia, a hand is used to palpate the needle tip suprapubically and guide the needle to the abdominal incision. |
6 - After the technique is repeated on the other side, the GYNECARE TVT sling is in place with the tape lying flat against the posterior surface of the midurethra. |
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| 7 - The needles are detached and an instrument is placed between the tape and the urethra. Gentle traction on each end brings the tape in contact with the urethra and correct tension is adjusted with an intraoperative cough stress test. |
8 - The incisions are closed. The completed procedure allows fixation of the tape below the
midurethra with the ends just below the skin level. |
For information about other Ambulatory Procedures, click here.
What Can You Expect
There are more than 300 different operations described in the medical literature for the treatment of stress urinary incontinence. This statistic is not only confusing for the consumer but to the physicians and surgeons who treat urinary incontinence. Fortunately the American Urological Association (AUA) established a task force to determine the most effective
operations in the literature for the treatment of stress urinary incontinence. They concluded
the most curative operations as published in the worldwide medically indexed literature were the: Burch urethral suspension procedure and the suburethral sling operation. Cure rates for both procedures were found to fall routinely between 80-90%.
The TVT operation is a "sling" operation and its cure rate falls within the international standards of cure for other types of sling procedures. Dr. Miklos' recent review of the English medically indexed literature show the TVT cure rates from around the world.
TVT Sling Documentation
Click on the author's name to read documents.
Are you a candidate for TVT?
The best way to determine if you are a candidate for this procedure is to consult your doctor. This procedure is appropriate for may types of patients, including overweight women and patients who have previously undergone other operations for incontinence. However experience on the part of the surgeon is especially necessary if the patient has undergone other operations in the past for incontinence. The blind retropubic passage of the TVT device can be much more difficult in patients with previous incontinence surgery due to the severe amount of scarring which occurs after such surgery.
Talk with your doctor...
Understand all your options
For whom is the TVT not recommended?
As with any surgery of this kind, this procedure should not be performed in pregnant patients. Additionally, because the mesh-like tape will not stretch significantly, the TVT procedure should not be used in women who plan future pregnancy.
What are the risks associated with TVT?
All surgical procedures carry risks. Although rare, complications associated with TVT include injury to blood vessels of the pelvic sidewall and abdominal wall, hematomas, urinary retention, and bladder and bowel injury.
LEARN THE FACTS by downloading this fact sheet about Gynecare TVT.
(PDF format) - Adobe Acrobat required. Don't have Acrobat? Click here.
CLICK HERE for prescribing information on Gynecare TVT.
(PDF format) - Adobe Acrobat required. Don't have Acrobat? Click here.
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