Stress incontinence in women can cause frequent involuntary release of urine during activities that put pressure on your bladder, such as coughing or laughing. The tension-free vaginal tape (TVT) procedure is designed to provide support for a sagging urethra so that when you cough or move vigorously or suddenly, the urethra can remain closed with no accidental release of urine.
In TVT surgery, a mesh tape is placed under your urethra like a sling or hammock to keep it in its normal position. The tape is inserted through tiny incisions in your abdomen and vaginal wall. No sutures are required to hold the tape in place. TVT surgery takes about 30 minutes and may be done under local anesthesia so you can cough at the surgeon's request to test the tape's support of your urethra.
Other sling surgeries are done in a way that is similar to TVT surgery. Transobturator tape (TOT) surgery is done almost as often as TVT in a slightly different way.
What To Expect After Surgery
Usually within hours of your surgery, you will be asked to urinate to test how your bladder and urethra respond to the surgery. You may be released to go home the same day as your surgery, or you may remain in the hospital overnight. You may need to have a thin, flexible tube (catheter) placed into your bladder through your urethra to allow urine to drain while you recover or to teach you to do self-catheterization temporarily.
TVT surgery usually causes minimal pain and discomfort. Although you may resume most normal activities in 1 to 2 weeks, you will be advised to refrain from driving for 2 weeks and from sexual intercourse or strenuous activities for 6 weeks.
Recovery times for TOT surgery are similar to those for TVT surgery.
Why It Is Done
Tension-free vaginal tape is used to correct stress incontinence caused by sagging of the urethra. It is a relatively simple procedure that can be done with minimal hospitalization and recovery time.
How Well It Works
Tension-free vaginal tape surgery works as well as the Burch colposuspension surgery to cure stress incontinence. About 8 out of 10 women are cured ("dry") in the year after TVT surgery. Long-term success rates are not known.1
Surgery time, hospital stay, and recovery time are all shorter for women who have TVT compared to women who have retropubic suspension surgery.
Transobturator tape (TOT) surgery seems to work almost as well as TVT to cure women who have stress incontinence, although the evidence is not as strong.2, 1
The most common risks of TVT surgery are:
Injury to the bladder or urethra (perforation).
Difficulty urinating after surgery.
Bladder injury and problems urinating after surgery are less common with TOT surgery. But TOT surgery has other risks including:
Groin pain after surgery.
Numbness or weakness in the groin or legs.
There is also a risk of problems caused by the mesh tape used in the surgery. These can include wearing away of the tissue in the pelvis.
All surgeries carry some risk of infection or other complications.
What To Think About
Before having surgery for urinary incontinence, ask your doctor about the following:
How much success has the doctor had in treating incontinence with surgery? The success of surgical procedures for urinary incontinence depends on the experience and skill of the surgeon.
Is there anything I can do to increase the likelihood of a successful surgery? Losing weight, quitting smoking, or doing pelvic floor (Kegel) exercises prior to surgery may increase the likelihood of regaining continence after surgery.
Ogah J, et al. (2009). Minimally invasive synthetic suburethral sling operations for stress urinary incontinence in women. Cochrane Database of Systematic Reviews (4).
Richter HE, et al. (2010). Retropubic versus transobturator midurethral slings for stress incontinence. New England Journal of Medicine, 362(22): 2066–2076.
The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.