TVT / Sling

The SUBURETHRAL SLING is a vaginal procedure used to correct (stress urinary incontinence) loss of urine during physical activity – running, jumping, coughing, sneezing, lifting etc.

Through a small vaginal incision a (sling) permanent mesh-like material (Prolene) is placed underneath the mid portion of the urethra. The mesh-like material remains as a permanent sling under the urethra. The Sling causes the urethra to close when the patient puts pressure on the bladder (strains, laughs, coughs, etc.). As a result, episodes of stress incontinence are prevented or improved.

Benefits include:

Minimally invasive outpatient procedure (approx 30 to 40 minute procedure) performed through Small vaginal incision.

Our Jacksonville bladder doctors have a high success rate in treating stress incontinence- 80 to 90% success rate.

50% chance of improving symptoms of overactive bladder (OAB) – sudden urge to urinate, frequent trips to the bathroom to urinate. Return to work quickly (1 week) - No heavy lifting, straining or sex for 4 to 6 weeks.

TRANS-OBTURATOR SLING – brand names include the TVT-O (Gynecare), Monarch (American medical Systems), OBTRYX (Boston Scientific), URETEX TO (CR Bard) etc.

MINI–SLINGS - brand names include the TVT- Secur (Gynecare), The Mini-Arch (American Medical Systems) etc. NOT all slings are the same - if you are going to have a “TVT” find out specifically what your doctor means by this- is it: RETROPUBIC, TRANS-OBTURATOR, MINI-SLING and is it a permanent synthetic material or a biologic material.

Do Your Homework!
Not all slings are the same.
Not all doctors have the same degree of experience.

Your best chance to successfully treat STRESS URINARY INCONTINENCE with a sling is with your FIRST procedure.

Clinical Data:
Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence.
Int Urogynecol J Pelvic Floor Dysfunct. 2008 Aug;19(8):1043-7. Epub 2008 Jun 6.
Nilsson CG, Palva K, Rezapour M, Falconer C.

The aim of this study was to evaluate the long-term effectiveness and safety of the tension-free vaginal tape (TVT) procedure. In a Nordic three-center prospective observational cohort study, 90 women with primary stress incontinence had a TVT operation performed in local anesthesia. Assessment included a 24-h pad test, a stress test, physical examination, and a visual analog scale for assessing the degree of bother. Patient's global impression of cure was obtained, and condition specific quality of life questionnaires were used. Seventy-seven percent of the initial cohort of 90 women and 89% of those alive and capable of cooperating were assessed 11.5 years after the TVT operation. Ninety percent of the women had both a negative stress test and a negative pad test being objectively cured. Subjective cure by patients global impression was found in 77%, 20% being improved and only 3% regarded the operation as a failure. No late-onset adverse effects of the operation were found, and no case of tape erosion was seen. The TVT procedure is safe and effective for more than 10 years.

"A three-year follow up of tension free vaginal tape for surgical treatment of female stress urinary incontinence",

Ulmsten et al, Br J Obstet Gynecol 1999 April:106(4) pp345-350.)
three year study: 86% of women were cured with another 11% significantly improved.

Surgical Intervention for Stress Urinary Incontinence: Comparison of Midurethral Sling Procedures

Joseph M. Novi, DO; Beth H.K. Mulvihill, DO
JAOA | Vol 108 | No 11 | November 2008 | 634-638

Context: The synthetic, tension-free midurethral sling was introduced in the 1990s as a surgical treatment for women with stress urinary incontinence (SUI). Several similar products are now available. The authors generated data comparing clinical outcomes of two midurethral sling procedures.

Objective: To compare clinical outcomes of two midurethral sling procedures currently used for the treatment of women with SUI: Gynecare Tension-free Vaginal Tape (TVT; Ethicon Women's Health & Urology, Somerville, NJ) and Uretex Self-Anchoring Urethral Support System (CR Bard Inc, Covington, Ga).

Methods: A nonrandomized, prospective study was conducted at a urogynecology practice with women who had preoperative urodynamically proven SUI. The study consisted of two phases: 100 consecutive cases using the TVT midurethral sling, then 100 consecutive cases using the Uretex midurethral sling. Symptom improvement was evaluated at 12-month postoperative follow-up by measuring rates of prolonged intermittent self-catheterization, urinary tract infection, urinary retention requiring urethrolysis, and new-onset urge incontinence.

Results: The TVT and Uretex groups were similar with respect to age, parity, and incidence of prior anti-incontinence surgery. There was no significant difference in outcomes measured between the two groups in symptom improvement at 12-month follow-up.

Conclusion: The TVT and Uretex midurethral slings demonstrate similar short-term improvement and complication rates in a nonrandomized population of women with SUI.

Prevalence of Persistent and De Novo Overactive Bladder Symptoms After the Tension-Free Vaginal Tape

Obstetrics & Gynecology:
December 2004 - Volume 104 - Issue 6 - pp 1263-1269
Segal, Jeffrey L. MD et al,

OBJECTIVE: The purpose of this study was to assess 1) the proportion of de novo urge incontinence and overactive bladder symptoms after a tension-free vaginal tape (TVT), and 2) the natural history of preoperative urge incontinence and overactive bladder symptoms after a TVT.

RESULTS: Ninety-eight patients were included in the study. Postoperatively, de novo urge incontinence symptoms developed in 9.1%, de novo overactive bladder symptoms developed in 4.3%, and 8.7% started taking anticholinergics for the first time. After a TVT, the urge component resolved in 63.1% of those with preoperative symptoms of mixed incontinence, overactive bladder symptoms resolved in 57.3% of those with preoperative overactive bladder symptoms, and 57.7% of those who used anticholinergics preoperatively no longer needed to do so. There was also a statistically significant improvement in comparing the preoperative and postoperative IIQ-7 and UDI-6 scores.

CONCLUSION: The proportion of patients in whom de novo overactive bladder or urge incontinence symptoms developed postoperatively is low, and approximately 57% of patients with preoperative overactive bladder symptoms can expect resolution of these symptoms after a TVT.

Do Your Homework!
Not all slings are the same.
Not all doctors have the same degree of experience

Your best chance to successfully treat STRESS URINARY INCONTINENCE with a sling is with your FIRST procedure.