Transvaginal Tape (TVT) and Transobturator Tape (TOT)

TVT and TOT are techniques of placing a synthetic mesh at the level of the mid-urethra to treat stress urinary incontinence. Stress incontinence is the involuntary leakage that occurs when there is an increase in abdominal pressure caused by physical activities like coughing, laughing, sneezing, lifting, straining, getting out of a chair or bending over. The major risk factor for stress incontinence is damage to pelvic muscles that may occur during pregnancy and childbirth. There are a variety of treatment options for this condition that are detailed in the AUA website that can be found at the following link: http://www.urologyhealth.org/urology/index.cfm?article=143.

TVT and TOT are usually done when the incontinence is severe or more conservative measures have failed. They are 85-90% successful in the treatment of stress incontinence. Both techniques are done under anesthesia in a hospital or outpatient surgery setting. They are done by placing the patient in the lithotomy position (similar to having a pelvic exam in a gynecologists office). After a thorough prep is done and a catheter is inserted, a vaginal incision is made. This is typically only half an inch in length. A space is then made between the urethra and the vaginal wall. This space is dissected on either side of the urethra to create a place for the mesh.

In a TVT technique, a kit is then used to pass the mesh on either side of the urethra upwards to the low abdominal wall just above the pubic bone. It is brought out through two small incisions in the skin, adjusted to a standard tension, and then the excess mesh is removed. Typically, the bladder and urethra are evaluated at the end of the procedure with a scope (cystoscopy) to be sure they are not injured, and then the incisions are closed.

In a TOT technique, the procedure is done in a similar fashion, but instead of bringing the mesh out through the low abdomen, incisions are made in each labia, and the mesh is brought out to the side from the vagina to the labia. This crosses through the obturator canal instead of the low abdomen.

What to expect afterwards:

  • Vaginal bleeding is common and expected afterwards. It is typically similar to a light period or spotting and may last for a few weeks although it will usually decrease daily.
  • Pain in one or both hips or groin is common with the TOT procedure and feels like a Charlie horse. This will typically improve over the first week.
  • Bruising at the abdominal sites with TVT or labial incisions with TOT may occur
  • Some women will find that they need to change position to urinate well afterwards (e.g. leaning forward). 
  • You should avoid intercourse, lifting with exertion (especially bending over), bathing and swimming for 6 weeks after surgery, although you may shower in two days.
  • You may be given a trial of urinating after the procedure before leaving the hospital or the catheter may stay in overnight and you will be taught how to remove it the following morning. 5-15% of women initially have difficulty urinating. In this situation, you will be sent home with a catheter after being instructed on its care. (This is typically removed in the office a few days to a week later). This can be the result of anesthesia as well as from pain, pain medication and decreased mobility. Less than 5% of women have persistent problems urinating requiring a return to surgery to loosen the sling.

The following is a link to the FDA warning as well as an example of the procedure:

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm

http://www.youtube.com/watch?v=QVwlahn1rKs&feature=related