TVT Sling (Tension-free Vaginal Tape)

What is a TVT Sling (Tension-free Vaginal Tape)

TVT Sling is an operation to treat stress urinary incontinence. Stress incontinence is leakage of urine that occurs with activities which cause an increase in abdominal pressure such as coughing, sneezing, jumping, lifting, exercising and in some cases walking.

This leakage occurs because the muscles at the bladder neck have lost their supports and strength. As a valve mechanism, the urethra (outlet pipe) no longer stays closed when extra pressure is put on the bladder.

TVT Sling is a minimally invasive operation requiring three small incisions to insert and position the tape. A 1cm cut is made on either side of the lower abdomen with a 4cm incision in the vagina to allow the tape to be put in place.

On average, women are in hospital 1 day following this type of surgery.

Before your operation

In the weeks just prior to surgery it is common to come to Urology Associates to see the continence advisor for a pre-op appointment.

You may have a routine blood test and a urine sample taken 1 week prior to your operation. Depending on your age and other medical problems you may also have an electrocardiogram (ECG) to record the electrical activity of your heart.

The operation and possible complications will be explained to you by the doctor. When you feel comfortable that you understand what is to be done and have had all your questions answered you will be asked to sign a consent form.

It is important to avoid constipation. Try to establish and maintain a regular, soft bowel habit leading up to your operation. Identify the foods that can help you in this area for your post-op period

Operation day

You will be advised when to come to hospital (usually by phone the day before your operation).

It is usual to stop eating and drinking at least 6-8 hours prior to surgery. You should bring your own medications with you and the staff will advise you if you need to take them on the day of your operation.

Before the operation you will be given supportive stockings to wear until you leave hospital to minimise the risk of blood clots forming. You may be asked to shave the top few centimetres of your pubic hair as this is where the incision in your abdomen will be.

Whether you have a spinal or general anaesthetic will be decided after discussion with the anaesthetist. This usually occurs during your pre-admission assessment or in the ward pre-operatively. Just prior to surgery you may be given a pre-medication tablet to relax you.

You will be encouraged to commence deep breathing and coughing exercises to prevent any breathing complications or chest infection occurring following the surgery and anaesthetic.

Recovery

When you first wake you will be in the recovery ward. You may feel sleepy and perhaps a little disorientated, but this feeling will pass.

You may eat and drink as desired but initially it is better to start slowly with fluids as the anaesthetic often makes people feel nauseated. There is medication available to control nausea if necessary.

An intravenous line (drip) may be attached to your arm overnight to give you some extra fluids. There will be a light dressing on your lower abdomen over the two small cuts.

Catheter

You will have a catheter (tube) in your bladder via your urethra, draining the urine into a bag. Your catheter will usually be removed the day after surgery.

After a normal intake of fluid it is usual to pass urine every 3-4 hours.
Initially you should not wait longer than this time before trying to empty your bladder. You may find emptying your bladder feels different as it recovers from the surgery and the associated swelling of the surrounding tissues.
Try to relax your abdominal muscles and the muscles underneath your bladder. Take your time and just let the urine flow out. Do not push or strain as this forces the urethra against the TVT sling, closing it off and stopping the flow of urine.
It is not uncommon to be unable to pass urine afterwards. If you cannot pass urine, can pass only a small amount or have bladder discomfort please let your nurse know. The nurse may check your residual urine, and arrange a self-catheterisation program if needed. This is called Clean Intermittent Catheterisation (C.I.C.) and can be performed in the privacy of your own bathroom or any toilet. Initially you may have to catheterise each time you need to pass urine but as things return to normal the frequency of your C.I.C. will be reduced.

Pain Control

While in hospital you will be prescribed Panadol and you should take this regularly to keep any discomfort to a minimum. Stronger medication is available if required.

The day following surgery your drip will be removed and you may eat and drink as usual. You will be encouraged to shower and mobilise around the ward in preparation for going home later that day.

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Lifting

Following surgery it is important to avoid any abdominal straining while your surgical repair heals. In particular you should avoid lifting heavy objects.

Bowels

Keeping a regular, soft bowel motion is important. While in hospital you will be prescribed a laxative such as lactulose to help avoid this. Kiwi fruit or “kiwi-crush” are also recommended.

After discharge

Our nurses will contact you by phone to check on your progress. If you have any concerns you may ring any time or arrange an appointment. You will also have a follow up consultation with your surgeon at approximately 6 weeks post surgery.

Pain control

Take regular pain control. Paracetamol (Panadol) is usually effective medication.

The more you do, the worse your abdominal pain will get. Use this as a guide for the amount of activity that you do over the next few weeks. If you are sore, rest. Wound pain sometimes may be worse on one side than the other.

Wound care

Your abdominal cuts and vaginal wound should heal within 7-10 days however the muscle layer beneath your skin will take up to 3 months to heal. The dressing tape can be removed after 7-10 days.

If you notice the cuts become inflamed, there is an increase in pain or it is red, hot or swollen contact Urology Associates for advice.

Vaginal discharge

It is normal to have some vaginal bleeding on and off for a few weeks and then a brown discharge for a few weeks following that. If the bleeding becomes heavy, you pass clots or have a smelly vaginal discharge, contact Urology Associates.

You may also notice the remains of some stitches in your underwear or in the toilet after voiding. Do not be concerned as these are vaginal stitches which have started to dissolve and that is expected.