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 (waterpipe) 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 1 cm cut is made on either side of the lower abdomen (tummy) with a 3 cm incision in the vagina to allow the tape to be put in place.
Women are usually in hospital for one night following this type of surgery.
Mesh slings have been around for more than 20 years and most women have had very successful results. The success rate is about 80%.
Erosion of the mesh into the bladder or urethra may occur in a small number of woman (<1%) sometimes many years after initial surgery. They will require surgery to remove this. This surgery may require going through the abdomen or the vagina.
Erosion of the mesh through the vaginal wall occurs in 2-8% of woman. If this occurs a further day surgery operation to cover or remove the mesh will be necessary.
Pain after the surgery is normal for 2-3 weeks. Uncommonly this pain in the lower abdomen may persist.
Mesh used to treat stress incontinence has a much lower risk of complication than that used to treat prolapse as a smaller piece of mesh is used. If you have concerns, discuss this with your urologist. Alternatives are available such as making the sling out of a piece of tendon from your abdomen.
Before your operation
In the weeks just prior to surgery it is common to come to Urology Associates to see the continence nurse specialist for a pre-op appointment.
You may have a routine blood test and a urine sample taken one 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.
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 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.
Whether you have a spinal or general anaesthetic will be decided after discussion with the anaesthetist. This usually occurs 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.
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.
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 (CIC) 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 CIC will be reduced. You would not be expected to do CIC in the long-term but sometimes just in the days and weeks following your surgery, as the swelling settles down.
While in hospital you will be prescribed paracetamol 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.
Following surgery it is important to avoid any abdominal straining while your surgical repair heals. In particular you should avoid lifting heavy objects for six weeks.
Keeping a regular, soft bowel motion is important. Kiwi fruit or "Kiwi Crush" are also recommended.
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 six weeks post surgery.
Take regular pain control. Paracetamol 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.
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.
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 emptying your bladder. Do not be concerned as these are vaginal stitches which have started to dissolve and that is expected.
Try to keep your bowel motions soft by using high fibre foods such as kiwi fruit, fruit, vegetables, wholemeal bread, nuts and seeds.
Do not become constipated or strain to have a bowel motion.
If you are constipated and conservative measures have not helped, take an oral laxative.
Use a footstool to help bowel emptying. Discuss this with our continence nurse specialist if you need further information.
Pelvic floor exercises
It is important to continue pelvic floor exercises once you have recovered from surgery. If you have any concerns about your technique, please contact our continence nurse specialist.
Initially when you go home you will not feel like doing very much, so listen to your body and rest. Sitting with your feet up will be the most comfortable position.