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Trans Vaginal Tape

Trans Vaginal Tape (TVT) for Urinary Incontinence
Urinary incontinence is one of the commonest symptoms suffered by women at all age groups. Unfortunately, due to embarrassment, especially Indian women prefer not to talk about it. A significant number of women can be helped with non-surgical treatments. However in some women, surgery is the only solution.

Trans Vaginal Tape (TVT)
This is a surgical procedure for treatment of Stress Urinary Incontinence (SUI) as well as Urge Urinary Incontinence (UUI). This as originally invented by Swedish surgeons in 1996 & so far more than 10 lac such procedures have been performed worldwide with excellent result.

Principles of TVT
The unique concept of TVT originates from the fact that mid part of the urethra is where maximum support is required to prevent urinary leakage. In TVT a tape is inserted from the lower part of the abdomen down into the peri-urethral tissue, supporting the mid urethra supporting the mid urethra in its posterior aspect without any tension, in a U-shaped manner. At the time of stress as cough, sneeze, the mid urethra remains closed due to gentle compression offered by the tape, thus preventing urinary leakage.

Brief description of the operation procedures
Usually local or spinal anaesthesia is used. The procedure is performed in lithotomy position. A small 1cm incision is made just below the urethral opening in the vaginal wall and a special blunt trocar with the tape wedged on to it is inserted from eh vagina up towards the suprapubic (lower abdomen) region. Absence of bladder injury is confirmed by telescopic examination of the bladder (cystoscopy). The other end of the tape with its separate trocar is passed on the other side of the urethra in a similar fashion & cystoscopy is repeated. A satisfactory tape tension is decided by pulling the tape upwards, enough, to just prevent any leakage. The extra length of the tape with the trocar is cut & discarded. The incision is closed with absorbable suture. Usually the procedure takes 30 to 45 mins. A temporary catheter is kept in the bladder for 24 hrs.

Post operative course
The patient is admitted on the day of the surgery. In the post operative period a catheter or a tube is kept in the bladder for 24 hours. On removal of the tube, once the patient starts emptying her bladder, she is discharged home. Thus normally only overnight hospitalization is required. Patients are given antibiotics for a day after the procedure. The procedure is remarkably comfortable for the patient & is practically painless. Some degree of discomfort may be experienced in the lower abdomen for the first few days but this usually responds to ordinary painkillers & settles over a period of time. Patients can return to their normal simple activity within a few days of their operation. However, any vigorous exercise such as aerobics, weight lifting, running, yoga etc should be avoided for 8 weeks. Similarly, sexual intercourse should be avoided during the same period.

The success rate of TVT
Reports from western (European & American) literature mention a 5-year success rate of up to 90%. This is comparable or even better than any of the previously prescribed procedures for treatment of SUI. As the procedure has been done in vogue only for 5 yrs, long-term success rates are not yet available. There are complications reported such as bladder injury, urethral injury, tape erosion etc. However, their incidence in good hands is minimal.