Tension-free Vaginal Tape (TVT)

Tension-free Vaginal Tape (TVT)
What is a Tension free vaginal tape?
Tension-free vaginal tape (TVT) is used to treat stress urinary incontinence symptoms. A
narrow ribbon of mesh (polypropylene) is placed underneath the urethra. It acts as a layer of
support so that the urethra is closed off when there is laughing, coughing, sneezing or exercising.
The mesh is passed behind the pubic bone and exits on the lower abdomen through two small
(1/2-inch) incisions on your lower abdomen below the bikini line.
When is this surgery used?
It is used to treat stress incontinence, which is a loss of urine with coughing, sneezing, laughing
or exercise. This surgery is NOT intended to relieve urge incontinence, which is a loss of urine
when you have the sudden urge to void.
How do I prepare for surgery?
Make sure you have made arrangements for your care and recovery after the surgery. Allow
enough time for rest. You may need someone to help with your day-to-day activities (family,
friend, home health aid). Your expected recovery time is 2-3 weeks.
If you have any medical problems, you will probably need a check-up to make sure you are in
good shape for your operation. We may ask you to see your primary doctor, specialist and/or an
anesthesiologist depending on your medical problems. We want to make sure that you are
approved for surgery. You will have all the necessary lab work that is ordered by your doctor
done at least 3 days before surgery.
Some medications need to be stopped for some time before the surgery. You should have
received a list of these medications during your visit.
Smoking can affect your recovery. Smokers heal more slowly after surgery and may have
difficulty breathing during the surgery. If you are a smoker, it is best to quit 6-8 weeks before
surgery. We can arrange for you to start a smoking cessation program if you are interested.
Your doctor can order a nicotine patch while you are an inpatient.
A pre-operative appointment will be scheduled for you. This will be scheduled either with your
doctor at their office or at Domino Farms with a nurse practitioner or physician assistant.
Before your surgery you will be asked to shower. Instructions will be provided at your preoperative appointment. Do not shave, wax or electrolysis the pubic area for 3-5 days before
surgery. This decreases your risk of skin infection.
Do not put on makeup, nail polish, lotion, deodorant, or antiperspirant on the morning of your
surgery. Please remove all body piercing and acrylic nails.
Bring a copy of your living will or an advance directive with you to the hospital on the day of
your surgery.
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What can I expect during the surgery?
Once in the operating room, you will be given either a spinal and/or general anesthesia before the
surgery to keep you from feeling pain. The choice of anesthesia is a decision that will be made
by anesthesia based upon your history and your wishes.
Compression devices will be placed around your calves. These are to prevent a blood clot in the
legs and the lungs during the surgery. These devices will stay on until you are actively walking.
If you are at a high risk for blood clots, a blood thinning medication may be given to you.
During the surgery, a tube (urinary catheter) will be inserted into your bladder to monitor the
amount of urine coming out. The inside of the bladder is examined with a camera to be certain
that there were no bladder injuries during placement of the sling. The urinary catheter will be
removed shortly after your surgery in most cases.
What are possible risks from this surgery?
As you may know, there can be complications that result from surgery. We work very hard to
make sure that your surgery is as safe as possible.
Potential risks include bleeding, injury to the bladder, bowel, or damage to the tubes that drain
the kidney into the bladder (ureters); infection, failure to cure the incontinence, development of
urge/urgency incontinence, inability to urinate without a urinary catheter, erosion of the mesh
into the vagina, the tubes that drain the kidney into the bladder, or bladder; blood clot near the
bladder, blood clot in the legs or the lungs.
An uncommon but possible complication is bleeding into the space between the bladder and the
pubic bone. This results in a blood clot and it occurs in <1% of cases. This will most often
resolve without further intervention. In rare cases, a blood transfusion is required. Even more
rare, sometimes additional surgery is needed to stop the bleeding. If the blood clot becomes
infected, you may need antibiotics.
If there is damage to the bladder, the tube in the bladder will remain in place at least overnight to
drain the bladder. Your doctor will need to discuss with you when it is safe to remove the
catheter. It is usually not necessary to keep the catheter in longer than 7 days.
Damage to the bowel or damage to the tubes that drain the kidney into the bladder is extremely
rare. If you are not improving after surgery (nausea, vomiting, increasing abdominal or back
pain); we will need to see you and evaluate for these extremely rare injuries.
If there is an infection, you will be placed on antibiotics.
10-20% of patients are unable to empty the bladder after surgery. This condition will resolve
within a few days in the majority of patients. 1-2% will have persistent problems requiring an
additional surgery.
Erosion of mesh occurs in 1-2% of patients. The most common site of erosion is into the vagina.
Estrogen cream will often help the vaginal tissue to heal over the mesh. Surgery to remove the
eroded mesh is sometimes necessary. Erosion into the urethra or the bladder is very uncommon
but does require removal of the mesh.
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If you develop a blood clot in the legs or lungs, you will be placed on blood thinning medication
for several months.
It is always difficult to talk about death as a possible consequence of surgery. We all do things
in our daily lives which have some small degree of risk, which we weigh against their benefit
(for example, driving a car home from the hospital has a small but real chance of death from an
automobile accident and does not prevent us from driving home). Surgery has become
tremendously safe in the modern era because of improvements in surgery, anesthesia and
antibiotic therapy. There is, however, a small but real chance of death from any operation. Be
assured that we take your surgery seriously and wish to make it as safe as possible. It is
important, however, for you and your family to consider these risks. The likelihood of dying
from this kind of surgery is quite rare (probably less than 1 in 1,000) but will vary depending
upon your medical problems. By signing the surgical consent permit, you are acknowledging
that you have honestly considered this issue and that you feel that the problem has been
bothersome enough for you that you wish to have the surgery performed. As we mentioned
before, please know that we will do everything that we can to minimize the chances of death or
serious injury and will make this a safe and positive experience for you and your family
What happens after the surgery?
You will be taken to the recovery room and monitored for a short time before going home. You
will be given an IV or oral medications for pain. Medications for nausea will be available.
You will probably still have the tube (urinary catheter) in your bladder. This tube will be
removed in the recovery room. Or, if you are staying overnight because of additional surgery,
the tube will be removed the next morning. Around the time of its removal, you will have a
voiding trial in which your ability to empty your bladder is assessed with a small ultrasound. If
you are unable to empty your bladder before discharge to home, you may be taught how to selfcatheterize, or you will be taught how to empty the indwelling catheter. Self-catheterization
involves placing a catheter into your urethra to allow your bladder to empty.
You will be given light refreshments. Your routine medications will likely be restarted. You
may have some vaginal spotting of bright red, brown, or black discharge.
You will be given a small plastic device to help your breathing after your surgery to help expand
your lungs while you’re in bed.
We encourage you to walk as soon as tolerated after the surgery to aid in your healing and
recovery.
What problems should I pay attention to after surgery once I’m at home?
Call your doctor right away if:
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If you start to bleed like a menstrual period or are changing a pad every hour
Develop a fever over 100.5°F (38°C)
Have severe pain in your abdomen or pelvis and the pain medication is not helping
Have heavy vaginal discharge with a bad odor
Persistent nausea and vomiting or if you are unable to hold any food or liquid down
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Chest pain or difficulty breathing
Leaking of fluid or blood or opening of the incision
If you develop swelling, redness, or pain in your legs
If you develop a rash
Pain with urination
Do I have any limitations after my surgery?
Activities:
Once you have settled into a more normal routine at home, you will find that
things slowly and gradually improve. Being up and around the house and taking
walks outside can help you to get back into shape gradually. It is important not to
overdo things but, on the other hand, it also is appropriate to be active in order to
get back into shape more quickly.
Energy level: It is normal to have a decreased energy level after surgery. During the first week
at home, you should minimize any strenuous activity. Over the course of the next
four weeks, your body will gradually heal, and your energy level will slowly rise.
Walking:
Normal physical activity is expected within hours of your surgery. Start with
short walks and gradually increase the distance and length of time that you walk.
Climbing:
Climbing stairs is permitted, but you may require some assistance initially.
Lifting:
For 6 weeks after your surgery you should not lift anything greater than 10
pounds (such as a gallon of milk), push heavy vacuum cleaners, or lift heavy
laundry baskets or exercise. Heavy objects increase the pressure in the abdomen
and push downward on the pelvic floor which can decrease the sling
effectiveness.
Showers:
Showers and bathing are allowed 24 hours after your surgery. If you take a bath,
you should not soak in this more than 10 minutes because the skin becomes soft
and then damaged from prolonged soaking. You may resume regular bath routine
3 weeks after surgery.
Exercise:
Exercising is important for a healthy lifestyle. Certain exercises, however, would
put the repair at a greater risk than others would. Exercises that involve impact
such as running, impact aerobics, jumping jacks or jumping rope all put
tremendous force on the pelvic floor. For this reason, these exercises should be
avoided until your post operative appointment. Bicycle riding and swimming are
ideal because they avoid unnecessary force on the pelvic floor. However, please
talk to your doctor regarding when you can start after your surgery.
Driving:
Do not drive if you are taking narcotic pain medications. The main reason
patients are asked to avoid or limit driving is related to pain following surgery.
You will be prescribed a strong narcotic (examples: Norco, Percocet, Vicodin) to
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help with the initial pain. These narcotics can be mind altering, making it unsafe
to drive while taking these medications. Even after finishing the narcotics, it is
possible that because of continued discomfort you will not be able to make
sudden movements while driving.
Urination:
Your urine stream will be slower after surgery. About 1-2 % of women will
experience incomplete bladder emptying longer then a few weeks after surgery.
Notify your surgeon if you are unable to urinate at all or feel you still have a
significant amount of urine that is unable to empty. This sometimes requires
additional surgery to either loosen or remove the mesh material.
Intercourse:
Avoid sexual activity until your follow-up visit with your doctor. At the follow-up
visit, the doctor will perform a pelvic exam and can make recommendations
regarding when it is appropriate for you to resume sexual activity.
Work:
Most patients will be able to return to work within 3 weeks after surgery. Some
patients may have residual fatigue for a couple of weeks.
Wound care
After the surgery, you will have incisions in 2 places: your lower abdomen below the bikini line
and another incision in your vagina. For the abdominal area, there will be a dressing over 2
small incisions which might be secured with small pieces of white tape called “steri-strips.” The
abdominal dressings might become soaked and need to be replaced. If this happens repeatedly,
please notify your surgeon. Some bleeding after the surgery is normal.
Your vaginal incision will be closed with dissolvable suture. It is common to need to wear a
protective pad for this spotting, but if you start to pass large clots of blood per vagina similar to
menstrual bleeding or are changing a pad every hour, please notify your surgeon. Some spotting
and vaginal discharge for up to six to eight weeks is normal following your surgery. This
discharge will then change to a brownish color followed by yellow cream color that will continue
for up to four to six weeks. It is common for the brownish discharge to have a strong odor
because this is old blood.
Diet
Resume your regular diet as prior to surgery.
Medications
Resume all of your regularly scheduled home medications as prior, unless otherwise specified. If
you normally use a vaginal estrogen cream, discuss with your surgeon when you should resume
this.
Pain: A pain medication will be prescribed for you after surgery. Do not take more frequently
than indicated on the instructions.
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Stool softener: A stool softener may be needed while taking prescription pain medications.
Follow-up
Before you leave the hospital you should have a post-operative appointment made with your
doctor between 4-6 weeks after surgery.
If you have any further questions or concerns regarding preparation for surgery, the
surgery itself, or postoperative expectations, please address them with your doctor.
Contact information
If you develop any signs of urinary tract infection such as fever greater than 100.5 degrees
Fahrenheit or higher, chills, persistent burning with urination, or persistent blood in the urine,
please contact the University Of Michigan, Department Of Urology at 734-936-7030 during
working hours (8:00 am– 5:00pm). Or, you have concerns, questions or a change in symptoms
that need to be addressed after business hours or on weekends, please call 734-936-6267 and ask
to speak with the Urology Resident on-call. If you need to be evaluated by a physician on an
emergent basis, please go to the nearest ER and have the ER physician contact the University of
Michigan for assistance.
Disclaimer: This document is for informational purposes only and is not intended to
take the place of the care and attention of your personal physician or other
professional medical services. Talk with your doctor if you have questions about
individual health concerns or specific treatment options.
©2012 The Regents of the University of Michigan
Last Revised: August 2013
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