A few years ago, a Swedish doctor developed a revolutionary surgical method for treating urinary incontinence — TVT (Tension Free Vaginal Tape), which is a vaginal supportive sling.
Today, this advanced method is successfully used by experienced urogynecologists at the Top Ichilov clinic. However, despite all its advantages, the TVT sling is recommended only after a detailed consultation with a urologist.
Urinary Incontinence in Women: Main Types
Urogynecology distinguishes several types of urinary incontinence, varying in their characteristics and severity of the problem.
50% of cases of urinary incontinence in women fall under the type “urge incontinence” (Urge Incontinence), where there is a strong urge to urinate, but the woman cannot reach the toilet in time. Typically, this problem includes frequent nighttime urination (nocturia). This issue cannot be resolved through surgery; appropriate medications and special pelvic floor exercises can help.
Another well-known type of urinary incontinence in women is “stress urinary incontinence” (Stress Urinary Incontinence). This includes urinary incontinence that occurs with increased abdominal pressure, for example, during
- coughing
- sneezing
- laughing
- lifting heavy objects
Stress urinary incontinence is considered normal in pregnant women (up to two months after childbirth) and is often seen in women over forty, especially during menopause.
In this case, pelvic floor exercises are also recommended (30% effectiveness), as well as injections of substances that cause the urethra to narrow (50% effectiveness). However, when all options are exhausted, surgery is performed. In the past, these were Burch and MMK surgeries, considered major surgeries that involved a large abdominal incision and various possible complications.
Stages of the TVT Sling Surgery
Nowadays, the third generation of TVT surgeries is being performed — TVTS (Tension Free Vaginal Tape Secure), the “stable supportive sling.” Its goal is to place a strip of synthetic material (polypropylene) under the urethra. The strip is intended to support the urethra during moments of increased intra-abdominal pressure. The difference in this new modification of the surgery is that the surgeon has the ability to tighten or loosen the sling during or even after the surgery, allowing for what is known as fine tuning — adjusting the optimal tension of the TVT sling to provide necessary support without obstructing urination.
Second-generation TVT surgeries are also very successful and have not lost their relevance. In these surgeries, the sling is placed under the bladder, accessed through the obturator membrane (Obturator membrane).
The surgery is performed under local anesthesia, regional, or spinal anesthesia. The surgeon makes a 2 cm incision in the vagina under the urethra and places the sling without suturing it to the tissues, allowing the TVT sling to integrate with the tissues during the healing process.
After the surgery, the patient spends a few hours in the ward and then is discharged from the hospital. Since the TVTS surgery is minimally invasive, the patient can fully return to her normal life within a day or two.