Midurethral Sling (TVT)

Midurethral Sling for Stress Urinary Incontinence

The gold standard of treatment for stress urinary incontinence (SUI) is a mid-urethral sling, also known as Tension-free Vaginal Tape or TVT.

The Procedure

A midurethral sling is a common, minimally-invasive outpatient procedure to treat stress urinary incontinence. It typically takes about 30 minutes and is performed in an outpatient surgical setting in which the patient goes home the same day.

The sling is made of polypropylene and is placed without tension around the urethra, providing a permanent repair. 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.

Dr. Shashoua has performed mid-urethral slings since 2001 and performs over 200 sling procedures a year.

The Results

The success rate of the midurethral sling for stress incontinence is over 90%. Success rates are lower in patients who have had prior slings or if they have both stress incontinence and urge incontinence. Success rates are also lower in patients undergoing a concomitant prolapse repair.

Complications are unusual but can include bladder injury, bleeding, infection and urinary retention. Other issues that are rare but have been reported, include vaginal pain or pain with intercourse after healing. Any time there is sling material placed within the vagina, there is a potential risk of sling exposure. Although the risk is low, this can occur if the incision does not heal properly and/or is not placed in the appropriate plane. In rare cases, reoperation or partial sling removal may be indicated.

Related Procedures

In some cases, an autologous sling or allograft sling is recommended. This is patient dependent and may be used in those with severe incontinence. An autologous sling uses fascia that is harvested from either the patient’s abdomen or thigh at the time of the procedure. Alternatively, a graft sling (Allograft) processed from human donor fascia can be used. These graft are placed around the urethra in the same fashion as the polypropylene mesh.

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 also done at the time of the sling.