Tension Free Vaginal Tape (TVT or Vaginal Sling): What is it and how is it placed?
Posted by
Armand RossettiNovember 06, 2008 8:41 AMTension free vaginal tape (TVT) is a relatively narrow strip of propylene mesh tape [1.1 cm (1/2 inch) X 40 cm (14 inches)] with two stainless steel needles, one at each end that surgeons insert at the mid urethra. Here is another graphic depiction of the bladder and urethra. Note that females may use Kegel exercises to strengthen the external sphincter.
Let’s take a look at some pictures of normal and compromised sphincters. Normal sphincters display the following characteristics they are closed at rest (Fig. a), closed with stress maneuvers (Fig. b) and have an excellent guarding reflex (Fig. c). The second set of pictures shows type II stress urinary incontinence (SUI); the sphincter is closed at rest (Fig. a), remains open with stress maneuvers (Fig. b) and has a good guarding reflex (Fig. c). With type III SUI, the sphincter is open at rest (Fig. a), it remains open with stress maneuvers (Fig. b) and has a weak guarding reflex (Fig. c).
Surgeons perform the TVT placement operation by making two small abdominal incisions just above the pubic bone. The operation requires either local or general anesthesia. The surgeon then places a Foley catheter and inserts the rigid catheter guide into the Foley catheter. Then an assistant pivots the handle of the guide to the surgeon’s left side to expose the patient’s left endopelvic fascia. The surgeon then punctures the fascia with one TVT needle end and advances the needle through a space and to the anterior abdominal wall. The needle must hug the posterior wall of the pubic symphysis during this operation. Then the surgeon tents up the abdominal skin with the needle (pokes the needle making the skin look like a tent), then incises the top of the tented skin and allows the needle to come through. It looks like this (however, the surgeon still has to perform a contralateral procedure, see below).
To make certain that the bladder is free of punctures as a result of the operation, the surgeon then fills the bladder with 250 ml of saline, leaves the needle where it is and performs a cytoscopic examination, looking for bladder leaks. Then the surgeon repeats the procedure on the other (contralateral) side.
The tape must not twist during the insertion. The surgeon then cuts the needles at each end and removes them, leaving the tape in place. After that, the surgeon fills the bladder with saline and has the patient perform a coughing test. The surgeon pulls the tape up on each side until only a few drops of saline exit the urethra when the patient coughs. The tension test is the probably most important part of the procedure.
Although the tape is marketed as tension free, the surgeon must make sure that it is tension free by performing a proper tension test. Then the surgeon removes the protective plastic sheath from the tape and closes the vaginal and abdominal incisions.
For more comprehensive information, please visit this website. And for those who are interested in viewing the full, comprehensive and well-explained procedure, you may access the video here.