The TVT-O (Tension Free Vaginal Tape Obturator) is the newest and safest technique or surgical procedure for the treatment of Urinary Stress Incontinence. It is an innovative, minimally invasive procedure with more than 90% success rate in treating Stress Urinary Incontinence.
Many women around the world are affected with Urinary Incontinence. Coughing, sneezing, laughing, exercise or heavy lifting is often accompanied by involuntary leakage of urine (Urinary Stress Incontinence).
It is commonly associated with aging but can also affect women of all ages. However, it is important to know that these are common treatable conditions and you don’t have to live with it. There are many treatment options that can help you gain control over this condition. With proper medical care and treatment, you can regain your quality of life.
There are 2 methods of correcting urinary stress incontinence:
1) Non-surgical methods
- Vaginal Pessary : A therapeutic pessary is a medical device much like the outer ring of a diaphragm. Therapeutic pessaries are utilized to support the uterus, vagina, bladder, or rectum.
- The Kegel Exercise is safe but would have to take 6 months until results would show, and does not guarantee full recovery.
- Incisionless Laser Correction : This new innovation has been recently introduced to Urogynecology and is now becoming a trend. This method is suitable for women with mild to moderate level of symptoms or for those with existing diseases that cannot be treated by TVT-O surgery.
2) Surgical methods
Urinary incontinence surgery is normally advised only when more conservative measures are not helping. Urinary incontinence surgery is a bit more invasive and carries a higher risk of complications compared to other treatments; however, it may also provide a long term solution in severe cases. Before you decide on urinary incontinence strategy, get an exact diagnosis. Several types of incontinence call for different surgical procedure.
- Urethral Sphingter or Bladder Neck Injection by Filler to avoid the premature opening of the urethra.
- Burch Colposuspension is the surgery of suturing the paravaginal tissues (near urethra) to periosteum of pubic bone.
- A-P Vaginal Repair can temporarily treat the Stress urinary incontinence. You are likely to experience the symptoms again in 5 years after the surgery.
- TVT-O (Tension Free Vaginal Tape Obturator) or Single Incision Sling (MiniArc Sling) is a minimally invasive procedure with an 85% – 90% success rate in treating Stress Urinary Incontinence.
Urethra is well supported,
consequently without urine leakage.
Urethra is not supported,
consequently urine leakage.
General Notes & Precautions
1) Important points to consider about TVT-O (Tension Free Vaginal Tape Obturator)
This surgery has limitations and cannot absolutely ensure satisfactory results, because there are so many factors affecting the surgery’s success, especially for women with Mixed Urinary Incontinence (those with overactive bladder). She needs continuous medications after TVT-O (Tension Free Vaginal Tape Obturator).
After the surgery, some of you may experience increase in urinary frequency, slow urinary flow and/or longer time of urination (compared with that before the surgery).
In case of unexpected surgical results or complications, corrective surgery is an option, and will be discussed between you and the surgeon. If the correction surgery wound occurs from a complication of the surgery, all expenses for services and treatment will no longer be charged to you. However, if the unsatisfactory results occur due to the complication from your non-compliance with the doctor’s orders, you will be charged accordingly.
This surgery is not allowed for women with immunodeficiency, and you must not become pregnant, or plan to become pregnant in the future because of risk of Stress Urinary incontinence recurrence during pregnancy and postpartum. In addition, this surgery is not recommended unless you have a discussion with your spouse because this may lead to problems, and misunderstandings caused by refraining from sexual intercourse for quite a time.
This surgery is performed in our operating room for approximately 1 hour under General Anesthesia administered by a board-certified anesthesiologist. You have to refrain from drinking water or food for at least 6 hours prior to the procedure in order to decrease the risk of aspirating gastric contents during or after surgery. This complication is very serious, and you need to strictly follow our recommendations.
The most important preparations you should know before the surgery are that you should take a rest (refrain from work) and be still for 2-3 days after the surgery to enable the wound to heal faster, and have little movement as possible to avoid wound disruption for 1 week after the surgery. You should refrain from some types of exercise affecting pelvic muscle movement and sexual intercourse for at least 6 weeks after the surgery.
2) Before the TVT-O (Tension Free Vaginal Tape Obturator)
Prior to the surgery, you will be invited to a pre-operative consultation room, where you will be evaluated for the surgery. You will be received by a member of the nursing staff in our Center, who will make inquiries regarding your previous medical history as well as arrange for your vital signs such as temperature, respiration, blood pressure, and pulse. In case of existing diseases or drug allergies, please inform the medical staff before the consultation. You should prepare and take with you any pills or treatment medications, you are currently taking.
You can possibly have the surgery done on the day of your consultation depending on the availability of Dr. Vitasna’s schedule. Otherwise, you may book for a possible surgery on the day of your consultation. This you may do through online pre-consultation and arrangement. It is best to undergo the surgery after your period. It is not advisable to do the surgery just before the period starts or during the period.
A staff nurse will usher you to a treatment room, where Dr. Vitasna will investigate your health history, and conduct both a general check-up and internal check-up. In case you have vaginal fungal or bacterial infection, you should completely treat it before the surgery to avoid wound infection after the surgery.
After the examination and assessment, you will discuss with Dr. Vitasna about your expectations and concerns. She will then explain to you about the methods (or techniques), processes of the surgery, some potential post-operative risks and complications prior to decision-making. You may also be asked if you have any allergies or any condition that wouldn’t make you a good candidate for the surgery as well as other additional inquiries.
After you have chosen the best alternative for your case, prices and quotes will be written down with you. —This ends your consultation.
3) The cost of TVT-O (Tension Free Vaginal Tape Obturator)
The cost of the surgery will include professional fees for the anesthesiologist and the surgeon, all the instruments, the home medications, and medicine used for the surgery as well. However, fees for laboratory workup for other existing diseases that you may have, and the professional fees for the anesthesiologist and the surgeon for corrective surgery are not included in the package.
4) Read more about : The Pre Operative Processes on the day of the Surgery
The Processes of the TVT-O (Tension Free Vaginal Tape Obturator)
1) About the TVT-O (Tension Free Vaginal Tape Obturator) Surgery
During the Tension Free Vaginal Tape Obturator (TVT-O) Surgery, while you are sleeping, Dr. Vitasna will begin the surgery at the area of the anterior vaginal wall with the incision wound length of about 1-2 centimeters. Then a special instrument will be used to insert the tension-free vaginal tape through the wound to bind (support) beneath the middle urethra, and the tape will be inserted outside via the Obturator Foramen to get outside both sides of your thighs (see illustration).
This surgery is called “Tension- Free” because the slings are not sutured into the muscle, fascia or bone. The incision at the anterior of the vaginal wall will be closed with absorbable sutures along the wound length. Vaginal packing is done for 24 hours after the surgery to control and stop the bleeding. The surgical wounds on both sides of thighs need to be covered with the gauze pack after the surgery to stop the bleeding.
Urinary frequency or difficulty in urination may be noted due to the surgery of the anterior vaginal wall, which affects the urethra. As a result of the difficulty in urination after the surgery, you may be catheterized for 1-2 days after the surgery.
The Tension Free Vaginal Tape Obturator (TVT-O) is one of the most complex and meticulous surgeries performed today. It requires extensive experience, precision, and accuracy to create the optimal results you desire and deserve. Many surgeons have little to no experience with this type of advanced cosmetic surgery. You should research and be conscious of the surgeon’s educational background, training, and practical experience.