Mid-Urethral Sling (TVT) for Stress Urinary Incontinence
The gold standard of treatment for stress urinary incontinence is a mid-urethral sling or Tension-Free Vaginal Tape (TVT).
The polypropylene sling is placed without tension around the urethra. The sling treats incontinence by providing support under the urethra when abdominal pressure is increased. Activities that stress the urethra include coughing, laughing, running, walking or jumping. The procedure typically takes about 30 minutes and is performed in an outpatient surgical setting in which the patient goes home the same day.
Dr. Shashoua has performed TVTs since 2001. The sling is made of permanent, synthetic material providing a permanent repair. Dr. Shashoua performs over 200 TVTs a year.
Success rates of the TVT for patients with no prior incontinence surgery is over 90%. Success rates in patients with prior incontinence surgery may be lower, depending on the individual patient. Complications occur in less than 2% of patients undergoing a TVT and can include bladder injury, bleeding, infection, urinary retention, and sling exposure. Most complications are managed without the need for additional surgery.
The mid urethral sling does not correct prolapse and does not elevate the vagina. The sling corrects incontinence by engaging under the urethra during activities that stress the urethra such as coughing, sneezing and exercising. Thus, mid urethral slings are not considered trans-vaginal mesh as it relates to the FDA communication on the safety and effectiveness of transvaginal placement of surgical mesh specifically for pelvic organ prolapse.
Another approach for the treatment of stress incontinence is an autologous pubovaginal sling using either abdominal fascia or tensor fascia lata from the upper thigh of the patient. Prior to the TVT, an autologous sling using the patient’s own tissue was the gold standard procedure for stress urinary incontinence. Currently, an autologous sling is placed in cases where a mid-urethral sling has failed, or when the patient is not a candidate for a synthetic sling.
Slings are not used to treat pelvic organ prolapse (cystocele, rectocele, or uterine prolapse). If pelvic organ prolapse is present and symptomatic, a prolapse repair surgery such as da Vinci Sacrocolpopexy or Vaginal Prolapse Repair is done at the time of sling.