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Operations: Needle suspension of bladder neck (TVT)

Insurance code: M5250

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: This operation is carried out to help urinary incontinence.

Description of procedure: The vaginal skin is opened beneath the urethra. A cystoscope (telescope) is placed in the bladder and an introducer is passed from below either side of the urethra carrying a stitch to the anterior abdominal wall. The stitch is then adjusted until the tension in the stitch is sufficient to prevent urinary leakage when pressure is placed on the full bladder. The vaginal skin is closed.

Anaesthetic: This operation can be carried out under either a general anaesthetic or with a spinal anaesthetic that uses local anaesthetic and a slight sedative.

Length of stay: The length of stay depends on how quickly bladder function returns to normal but an overnight stay is typical.

Post-operative management: Patients will be encouraged to drink freely and pass urine when the bladder feels full. The amount of urine passed will be measured and compared to the volume left behind in the bladder. Once the residual urine is less than 100 mls on 3 occasions the catheter will be removed.

Potential complications
Complications at the time of surgery include peri-operative bleeding, and damage to structures such as the bladder, urethra or ureters. These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn and heparin injections given each day to reduce the risk. Early mobilisation and early discharge from hospital reduce the risk of thrombosis. Bladder related complications are common and include urinary urgency, urge incontinence, incomplete voiding and recurrent urinary tract infections. If incomplete bladder emptying is recognised in the first 48 hours a gentle release of the tape can be carried out under general anaesthetic to make it easier for urine to flow. This is required in 5% of cases.

Post-operative consultation
A routine appointment is normally booked for three weeks or six weeks to ensure the operation has been successful and ensure the skin has healed well.

Other considerations
Sex is best avoided until the skin has healed and sutures have dissolved. This operation has been superseded in most cases by trans-obturator tape insertion.

Relevant websites

Guidelines on management of urinary incontinence. Requires Adobe acrobat reader.

Good information from the Royal College of Obstetricians and Gynaecologists on surgery for urinary incontinence.