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Tension-Free Vaginal Tape (TVT)

Urinary Incontinence, A Little Tape Can Cure It

 By Dr. Gifford Jones  Tuesday, October 12, 2010

A woman recently complained to me, “I’d give all I own to be rid of the continual loss of urine. I’m embarrassed and I’ve become a social outcast. It’s ruined my life.” Today, with an aging population, 12 million North American women suffer from this disabling problem. And for years the ingenuity of surgeons has been taxed in the effort to ease their suffering. Now, a new technique is curing thousands of incontinent women. All it takes is a small piece of Tension-Free Vaginal Tape (TVT).

Urinary incontinence occurs when the pressure inside the bladder exceeds the pressure in the urethra, the tube that conveys urine to the outside. The first symptom is often a feeling that something is falling down in the vagina. This is followed by stress urinary incontinence (SUI), a loss of urine on coughing, sneezing, sitting down or jogging. In the great majority of cases the injury to the bladder and urethra occurs during difficult childbirth.

The time-honoured treatment for SUI involves surgical stitching of vaginal and urethra tissues back into their normal position. This treatment cures many women. But it’s a major operation requiring general anesthesia, several days in hospital and pain. And unfortunately SUI may recur months or years later. Then women have to face other more complicated procedures with no guarantee of success.

In the 1990’s a Swedish urologist Dr. Ulf Ulmsten began experimenting with another approach to treat SUI. The method he started to use was quite simple.

I’m sure few can count the number of times they’ve sucked up soda pop through a straw. And they know that bending the straw stops the flow. So Dr. Ulmsten reasoned, why not place a sling underneath the urethra and bend it just enough to cure urinary incontinence?

Unlike traditional operations surgery using TVT does not involve extensive cutting and stitching of tissues.

TVT is day surgery. It involves minimal discomfort, takes about 30 minutes and can be performed usually under local anesthesia. Keeping the patient awake allows the surgeon to evaluate whether the tape is providing adequate support. If a loss of urine occurs when the patient coughs, adjustments to the tape’s pressure can be made at that time.

During the procedure a small vaginal incision is made underneath the urinary tube. Two one-half inch cuts are then made in the lower abdomen near the pubic bone. The surgeon then places the tape under the urethra and gradually burrows it upward through the abdominal wall. The ends of the tape are then stitched to the tissues just beneath the skin.

In Canada 7,500 women suffering from SUI have been treated by this technique. And after five years there’s still no evidence of the tension-free vaginal tape being rejected by the body.

TVT can be used for overweight patients and for those who have undergone other operations for incontinence. But this procedure should not be performed in pregnant patients or for women who plan a future pregnancy.

The complication rate is small. 90 percent of patients are able to void within 24 hours. Others require a catheter for a few days while the bladder adjusts to the surgery.

And only about five percent of patients encounter pain on voiding for a few days.

World-wide data reveals that in a few cases the bladder and bowel have been injured by the surgery. But these injuries occurred initially while surgeons were gaining experience. Like any surgical procedure practice makes perfect.

Worldwide 200,000 operations using the TVT sling have been performed. Studies show that five years after the procedure 80 to 90 percent of women are cured of their incontinence. For those not completely cured 11 percent have had significant improvement. There’s little doubt that TVT represents one of the most important advances in recent years.

November is “Incontinence Awareness Month”. So if you’re suffering from SUI don’t be embarrassed to talk about it with your doctor. Being free of this daily annoyance can enhance your freedom and your quality of life.

You can obtain more information about TVT on the web site http://www.gynecare.com

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Dr. Gifford Jones  Bio
Dr. Gifford Jones Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He’s been a ship’s surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: http://www.mydoctor.ca/gifford-jones

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