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Guidelines Meeting— January 2010, V4 Aug 2012, V5 Jul 2014
Patient Questionnaires— Done
Equality Impact Assessment— April 2010
Scrutiny Panel—May 2010
Divisional Board—May 2010, V4 Sept 2012. O&G SDU V5 Sep 2014
Clinical Guidelines Subgroup—Not required
Patient Experience Group— Feb 2008.V5 Nov 2014
Women & Children’s Directorate
How can I help to reduce Healthcare Associated
Infections?
Infection control is important to the wellbeing of our patients,
and for that reason we have infection control procedures in
place. Keeping your hands clean is an effective way of
preventing the spread of infections. We ask that you, and
anyone visiting you, use the hand sanitiser available at the
main entrance of the hospital and at the entrance to every
clinical area before coming into and after leaving the clinical
area or hospital. In some situations hands may need to be
washed at the sink using soap and water rather than using
the hand sanitiser. Staff will let you know if this is the case.
www.buckshealthcare.nhs.uk
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TVT Procedure
(Tension-free Vaginal Tape)
Patient Information Leaflet
If you require a translation of this leaflet please call Ward 16
Safe & compassionate care,
Author: Mr I Currie/Miss A Patil
Issue date: November 2014
Review date: November 2017
Leaflet code: WZZ1038
Version: 5
every time
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This leaflet is for women who have been advised to have a
Tension-free Vaginal Tape (TVT) procedure. It tells you what
the operation will involve, what will happen when you come to
the hospital, the potential benefits and risks, and what to
expect after the operation.
If you have any questions or concerns, please phone Ward 16
at Stoke Mandeville Hospital on 01296 418111 and ask to
speak to a member of the nursing staff.
What is a TVT procedure?
A TVT (Tension-free Vaginal Tape) procedure is an operation
that is performed to help women with stress urinary
incontinence – the leakage of urine when coughing, sneezing
or moving.
A ribbon-like tape of synthetic mesh will be inserted and
placed in one of three possible ways, based on your doctor’s
assessment (see diagrams). This tape forms a sling that
supports the bladder entrance (urethra) and remains
permanently in place. Body tissue soon grows within it; this is
normal and not harmful.
The operation only takes about thirty minutes. It is usually
performed under general anaesthetic. You will have two tiny
incisions (cuts), either just above the pubic area or near the
creases on the thighs, (depending on the type of the tape) and
one small incision inside your vagina.
What are the chances of success?
This operation was invented in 1996 and more than 1.4 million
women have been treated with TVT worldwide. It restores
continence in about 80 out of 100 women, with a further 14 out
of 100 having improved bladder control but not completely cured.
We don’t know whether it will have complications in the long term.
[The operation is still relatively new but has been performed in
Scandinavian countries for at least 15 years. Research from
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Other information and organisations
Incontact
Tel: 0870 770 3246
Email: [email protected]
Website:
The Continence Foundation
Tel: 0845 345 0165
Email: [email protected]
Website: www.continence-foundation.org.uk
Useful Contact Numbers
Stoke Mandeville Hospital
Consultant Gynaecologists
Wycombe Hospital
Consultant Gynaecologists
01296 316163
01296 316121
01494 425009
01494 425512
This leaflet explains some of the most common side-effects
that some people may experience. However, it is not
comprehensive. If you experience other side-effects and want
to ask anything else related to your treatment please speak to
Ward 16 on 01296 418111
We continually strive to improve the quality of information given to
patients. If you have any comments or suggestions regarding this
information booklet, please contact:
Women & Children’s Directorate
Buckinghamshire Healthcare NHS Trust
Stoke Mandeville Hospital
Mandeville Road, Aylesbury
Buckinghamshire HP21 8AL
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There are stitches in the skin wound in the vagina. The
surface knots of the stitches may appear on your underwear or
pads after about two weeks, this is quite normal. There may be
little bleeding again after about two weeks when the surface knots
fall off, this is nothing to worry about. There are also
stitches in the pubic area. These will dissolve too.
What if I have problems after leaving hospital?
If you have any problems you should contact your GP in the
first instance. If it is urgent, contact your local Casualty Department.
Nursing staff on the ward will always be happy to answer any queries
that you may have. We will arrange a courtesy telephone call after
surgery, but your primary follow up is with your GP at 6 weeks.
Sweden suggests that once the operation is successful it is likely to
go on working for many years.]
What are the risks?
With any operation there is a risk of complications. The following
complications can occur with a TVT:
General risks of the surgery:
• Risks from the anaesthetic: modern anaesthesia is
fairly safe. The anaesthetist will explain about the risks
associated with general or spinal anaesthetic.
•
•
•
•
Sources and acknowledgements
This information in this leaflet is based on the Royal College of
Obstetricians and Gynaecologists (RCOG) guideline
Surgical Treatment of Urodynamic Stress Incontinence,
published by the RCOG in October 2003.
The British Society of Urogynaecology (BSUG)
www.busg.org.uk.
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Bleeding during/after the operation: some vaginal
bleeding is common afterwards and may take a day or
two to settle. More significant bleeding or haematoma
(localised collection of blood) is rare, affecting only about
1% of women.
An operation through the abdomen to stop this bleeding
may need to be performed in this situation. Risk of blood
transfusion due to bleeding is 1%.
Infection: There is a risk of infection at any of the wound
sites. A significant infection is rare. The risk of infection is
reduced by our policy of routinely giving antibiotics with major
surgery.
Clots in legs and lungs (thrombosis): these are potentially
serious complications of any operation, but the risk is low
because of the speedy mobilisation following surgery. You will be
given white stockings and an injection of a blood thinning agent
(Fragmin) for prevention of thrombosis.
Specific Risks of this Surgery:
• Failure: 10% of women do not gain benefit from the operation,
although the operation can be repeated.
•
Inability to empty the bladder properly (Voiding difficulty):
Approximately 10% of women will have some difficulty in
emptying their bladder in the short term but
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usually settles as any bruising and swelling around the tape
subsides. If this happens, we may send you home with a
catheter for about 24-48 hours. You will be followed up in the
ward to recheck your bladder emptying.
•
•
•
If you still have difficulty emptying your bladder after 7-10 days
(3%), then the options will be either learning how to catheterise
yourself (you may need to do that few times a day after passing
urine, to get rid of any urine left behind in your bladder), or going
back to theatre to have the tape cut . Once the tape is cut, you
may re-develop incontinence, but there is an option of having
another tape at a later date.
Bladder over-activity: (12%): Any operation around the bladder
has the potential for making the bladder overactive leading to
symptoms such as urgency (needing to rush to the toilet) and
frequency (needing to visit the toilet more often than normal).
These symptoms can usually be improved with tablets.
Women who are known to have an overactive bladder before the
operation may find that their urgency and incontinence getting
worse after surgery. Such women often need to take tablets for
their overactive bladder after surgery.
Bladder infection (cystitis): this is not uncommon and
treatment with a course of antibiotics is usually effective.
Tape exposure and extrusion: (5%): On rare occasions,
a portion of the tape may become exposed in the vagina. This
can be treated by a small operation to re-cover the tape. The
vaginal area over the tape may not heal properly or get infected
and therefore part of the tape may need excising. This may
result in a return to theatre and may result in the operation being
ineffective.
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When can I resume intercourse?
We advise that you wait six weeks before resuming sexual
intercourse, to allow time for internal healing. It is important
that the area within the vagina is healed well before intercourse
takes place.
When can I start exercising again?
We advise you to avoid heavy lifting and sport for 6 weeks
after surgery, to allow time for the wounds to heal and the
mesh to settle into place. Reasonable activity can be resumed
after 2 weeks. You can do pelvic floor exercises but build these
up very gently. If you do too much it will be uncomfortable.
When can I drive?
Provided you are comfortable sitting in a car seat and can
perform an emergency stop without pain or discomfort, it is
safe to drive. We recommend short distances initially,
gradually building up to longer journeys. We strongly advise
that you check with your insurance company in the first instance;
many companies have strict guidelines and timeframes with
regard to driving and liability after major surgery.
At home after the operation
After any operation you will feel tired and it is important to rest.
It is also important not to take to your bed. Mobilization is very
important. Simply pottering around the house will use your leg
muscles and reduce the risk of clots in the back of the legs (DVT)
which can be very dangerous. Activity will also help to get air into
your lungs and reduce infections.
It is advisable to have showers rather than baths for three
weeks and to keep puncture wounds clean and dry.
Do not use tampons, have intercourse or swim for 6 weeks
otherwise you put yourself at risk of the tape eroding into the
vagina.
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What will happen after the operation?
After the operation we will take you to the recovery room. Once you
are awake and breathing on your own, we will take you back to the
ward. You may have:
•
•
•
a mask supplying oxygen;
narrow tube into your vein to replace lost fluids;
a catheter (tube) draining the urine from the bladder
until you are able to go to the toilet yourself.
You may have some pain and discomfort after your surgery. To keep
you pain free and comfortable, we will offer you a painkiller every four
to six hours.
When you are awake enough, the nurse will offer you something to
eat and drink. The anaesthetic may make you feel a little sick until the
effect wears off.
If the nurses are happy with the amount of urine passed and the
amount left behind in the bladder is satisfactory, you will be able to go
home the same day. If you need to have a catheter you will still be
able to go home with a catheter and a leg-bag. You will be given an
appointment to come back to the ward the next day to re-check your
bladder emptying.
If you have had additional surgery, you may need to stay in for 3-4
days. You must arrange for an adult to take you home in a private car
or taxi.
How long will I take to recover?
Because major incisions are avoided, recovery is much
quicker.
At 2 weeks gradually build up your level of activity. After 4-6
weeks you should be able to return completely to your usual
level of activity. You should be able to return to a light job after
about 3-4 weeks. Leave a very heavy or busy job until 6 weeks
after surgery.
It is important to avoid straining particularly in the first weeks after
surgery. Therefore, avoid constipation and heavy lifting.
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•
•
Very rarely the tape might erode into the urethra (urine pipe) or
the bladder which would require a further operation as well. The
risk of exposure is increased by smoking, increased body
weight and with certain diseases.
Lower pelvic pain, groin pain or pain on intercourse:
This may arise from scar tissue in the vagina as a result of the
incision. It is unusual but unpredictable.
Injury to the surrounding organs (Visceral trauma)
•
Injury to the bladder (perforation): Risk of the TVT needle
passing through the bladder wall is about 1-5%. This is
usually recognised during the operation (during camera
examination of bladder—cystoscopy) and this is not a serious
problem as the bladder heals very well. The needle will be
removed and repositioned. A catheter would usually be left in
the bladder for 24-48 hours and you would need to take
antibiotic tablets for a week.
•
•
•
Injury to the urethra: It is very rare and if occurs, then it
requires a formal repair of the damaged area. After repair, a
catheter is passed into the bladder for a few days. The choice
of placing or not placing a tape depends upon the severity of
the injury.
Nerve injury: Very few cases of Obturator nerve injuries
due to TVT have been reported and occur at an incidence
of around 0.2%. It can cause persistent groin pain or hip joint
pain and may require a further surgery to relieve the pain.
Injury to the bowel: This is rare but if occurs and is
noticed at the time of surgery, it may require an abdominal
incision (open tummy operation) to repair the damaged
organ. If it is noticed after return from theatre to the ward
it may necessitate going back to theatre for a general
anaesthetic and an abdominal incision to repair the
damaged organ.
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Are there any alternatives to TVT?
Do nothing – if the leakage is minimal and not distressing then
treatment is not necessarily needed.
Pelvic floor exercises are usually the first step in managing
mild symptoms of stress incontinence. The exercises have to
be done every day and are successful in achieving a cure in
70% of cases. Pelvic floor exercises are best taught by an
expert who is usually a Physiotherapist. These exercises have
little or no risk and even if surgery is required at a later date,
they will help your overall chance of being more comfortable.
Conventional major surgery (for example, Colposuspension)
may achieve a similar success rate(80-90%) to TVT but it is
major abdominal surgery. There is usually a four to six day
stay in hospital. This is associated with more morbidity (risks
or complications) and delayed return to normal activities.
Injection of a bulking agent (Bulkamid) around the bladder
neck can prevent it opening too early. Overall it is reported to
cure or substantially improve stress incontinence in 50-60% of
women, however has fewer risks than TVT. It is offered to
women who are reluctant or not medically fit enough to have
more major surgery or who are planning to have more children.
What happens on the day of the operation?
You will be asked to come to the hospital in the morning on the
same day as your operation. You will be asked not to eat or drink
anything from midnight the night before until your operation is
completed and you are back from surgery.
One of the anaesthetists who will be giving you your
anaesthetic will come to see you. Please tell the anaesthetist
about any chest troubles, dental treatment, any previous
anaesthetics you have had, and also any anaesthetic problems
within the family.
You will be seen by the surgeon (or a senior member of
the team), who will explain the purpose of the operation,
what will happen during the operation and the risks associated
with it. You will be asked to sign a consent form, which gives us
permission to perform the operation, if you have not already
done so. You will have an opportunity to ask any further questions.
Tape
The effect of injections can ‘wear off’ and become less effective
and you may have to have the procedure repeated.
The pre-operative clinic
A few weeks before your surgery we will invite you to a
preoperative clinic where you will be assessed for surgery.
You will be seen by a member of the nursing staff or a doctor,
who will ask questions about your previous medical history
and will arrange for some tests (for example: blood test, ECG,
chest X-ray).
Bladder
Pelvis
Urethra
TVT : retropubic approach
Alternative ways of
placing the TVT
sling
TVT : transobturator approach
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