Trans Vaginal Tape Repair
What is a Trans Vaginal Tape Repair?
TVT (trans-vaginal tape) is a minimally invasive surgical procedure for treatment of female stress incontinence that combines the use of a mesh tape, with a traditional incontinence procedure called the sling to support the urethra. The mesh tape loosely supports the middle of the urethra and provides support only when needed, without the tension associated with traditional sling procedure. It creates a “new” hammock for the urethra.
The surgery takes only 30 to 45 minutes. The tape is surgically inserted through a small incision in the vagina and then it is woven through pelvic tissue and positioned underneath the urethra. The tape is then pulled up through two tiny incisions in the skin’s surface just above the pubic area. As it passes through several pelvic tissue layers, friction is created which initially holds the tape in place (like Velcro). Over time your body tissue grows into the mesh which permanently secures it. At the end of the procedure the tape is trimmed just under the skin’s surface and the tiny incisions closed. All you will see are two adhesive bandages.
Surgery complications and risks
All surgical procedures may have risks and complications. Published papers and personal medical experiences on the procedure suggest that complications may occur. However, the total published rate of complications using the TVT sling device has been minimal.
Minor complications of this procedure include bladder perforation; post-operative voiding problems; urgency and urge incontinence which is associated with all incontinence surgeries; bladder instability or bladder spasm and infection. With each of these minor complications there are management plans and when put in place have positive results.
Expected length of Hospital Stay = Overnight stay.
Prior to discharge:
- You will be independently mobile, attending to your daily needs.
- You will be able to pass urine normally OR you will be managing self catheterisation.
- Your pain will be controlled with oral analgesia.
- You will return to and tolerate your usual diet.
- Should you require community services, these will be organised for you.
Mater Private Hospital Redland provides a preadmission health assessment on the information you have provided to us. You may receive a phone call, if required, to clarify any health information you have provided. You can expect to stay in hospital overnight or until you have met the expected outcomes of your procedure. To prepare for your discharge we must discuss what support and potential needs you will have at home. This preadmission service gathers information, initiates investigations to prepare you for your surgery, provides information regarding your specific operation and identifies discharge needs.
Things to do before you come to hospital:
- Any blood tests, x-rays, ECG or other procedures that your surgeon may have ordered need to be completed before you come to hospital.
- It is important for you to bring x-rays and any medications that you take. Your medications need to be in their labelled containers or Webster pack.
- If you are taking any blood thinning or arthritis medications please follow instructions provided by your specialist, as sometimes it is important that these medications be stopped in preparation for your surgery.
- It is necessary that you have nothing to eat or drink (including water, lollies and chewing gum) at least six hours before your operation. Please follow instructions provided by your doctor.
- It is important for you to shower then dress into clean clothes prior to coming into hospital. No skin products are to be used following your shower (e.g. deodorant, perfume, body lotion, powder).
What to bring to hospital:
- Your Medicare card.
- All regular tablets or medications in their original boxes/bottles.
- Any relevant x-rays, scans or ultrasounds.
- Glasses, contact lenses and hearing aid if required.
- Night clothes and toiletries (shampoo, soap, toothbrush, toothpaste).
- Day clothes that are loose fitting and comfortable.
As Mater Private Hospital Redland is unable to accept liability for losses it is highly recommended that you leave your valuables at home for safety and security purposes. Please bring essential items only.
Day of Admission and Surgery
Before your operation
Your surgeon will advise you when to stop eating and drinking in preparation for your surgery. It is important not to have food or fluids for at least six hours before your operation. Failure to comply will require your operation be cancelled. You may brush your teeth the morning of your surgery without swallowing any water.
- When you come to hospital proceed to reception at Mater Private Hospital Redland foyer. You will be directed to where you will be admitted.
- Your admitting nurse will greet you, show you around your room and explain the facilities there is a safe provided in the cupboard for you to store any valuables that you have brought with you. However it is recommended that you leave any valuables at home.
- You will have an armband applied which will stay on for the duration of your stay for identification and safety reasons.
- The assessment form completed at the preadmission service will be reviewed and your health team will plan for your individualised care while in hospital and any support you may require after discharge. Your nurse will also check that your consent form has been signed or organised to be signed before your operation.
- You can expect to be in hospital overnight or until the expected outcomes for your procedure have been met. Your nurse will discuss with you any needs that you may have following your discharge home.
- Please inform staff if you are currently using a community service. i.e. Blue Nurses.
Teaching and Emotional Support
- Your nurse will explain to you the pre-op/surgical/post-op routine.
- Any questions you may have in regards to your surgery or recovery will be answered.
- If you would like pastoral care to visit you, please let the staff know and this can be arranged.
- Following your operation you will be transferred to the recovery room where you will be observed closely for approximately one hour. You will then be transferred back to your room on your bed once you are fully awake and stable.
- Your physiotherapist will visit to explain exercises that will help with your post-op recovery.
- Deep breathing, coughing and leg exercises are important for you to do while you are resting in bed after your surgery. These exercises help your circulation and prevent the possibility of clots forming in your veins. Once each hour take five or six deep, slow breaths – relax your shoulders as you breathe out. Bend ankles up and down 10 times every 30 minutes.
- To facilitate the deep breathing and coughing, a device known as a TRI-FLO may be given to you.
Following surgery you will be resting in bed. You will be encouraged to practice your post-op breathing and circulation exercises.
Your surgeon, anaesthetist and pharmacist may visit with you prior to your surgery. It is important that you raise any concerns regarding your surgery or medications with them. A physiotherapist may also visit (if requested by your surgeon) and go through exercises with you.
- Once you have showered (at home or on admission) you will be required to dress in a theatre gown and some paper pants in preparation for your surgery. Apart from your wedding band, no jewellery or metal is to be worn to theatre. Some tape will be wrapped around your wedding band to cover it.
- After you return to the ward you will be given a sponge bath and dressed in a clean gown.
- Following surgery you may have small sips of water or ice to suck on.
- You will also be given fluids via your I.V drip.
- On admission you may be asked for a urine sample for testing.
- You may require a small enema if your bowels have not opened.
- After surgery you will have a catheter in place to drain urine from your bladder.
- On admission your nurse will take your observations (e.g. temperature, pulse, blood pressure and weight).
- After surgery the nurse will observe your vital signs for several hours. These observations will become less frequent as you stabilise post-op.
- You will be observed for any vaginal discharge.
- Following surgery you will have an I.V. drip to maintain your fluid intake, pain relief and antibiotic coverage during your post-op period.
- You must let your nurse know if you have any pain or nausea, as your medications can be adjusted accordingly.
- You will be measured for anti-embolic stockings (TEDS) and will need to have these put on prior to going to theatre.
- A Sequenced Pressure Device (SCDS) will be applied to both your legs before surgery. This helps circulate the blood from your legs back to the heart while you are immobile, reducing the risk of clot formation.
It is expected you will be going home today. Discuss any concerns you may have with the staff.
Your surgeon, anaesthetist and pharmacist may visit with you after your surgery. It is important that you raise any concerns regarding your surgery or medications with them. A physiotherapist may also visit (if requested by your surgeon) and go through exercises with you.
You are free to mobilise independently today.
You are free to shower independently. Assistance will be provided if necessary.
You will have progressed today to a normal diet.
- Your catheter will be removed today
- When your catheter is removed: Each time you want to pass urine please notify your nurse. It is important for your nurse to measure the amount of urine passed and then scan your bladder with an ultrasound device. This is called “Trial of Void” and is done to ensure your bladder is emptying sufficiently.
- Please notify your nursing staff if you are:
- having difficulty passing urine
- passing urine frequently
- experiencing pain or burning when you pass urine.
- It is expected that you will be passing urine normally today however it is not unusual to experience difficulty passing urine on removal of your catheter. Your nurse will discuss an appropriate plan of care with you should this occur.
- Your temperature, pulse, respirations and blood pressure will continue to be monitored until you go home.
- Your vaginal discharge will be noted.
- Your I.V. drip may be removed.
- If you have any pain it will be controlled with oral analgesia. Remember to let your nurse know if you have any pain.
- Before you go home your medications will be summarised for you on a discharge advice form which will be given to you.
- You need to continue to wear your stockings as ordered. The SCDS will be removed when you are able to walk around.
- Continue to wear your stockings – especially overnight for one to two weeks.
- You will be encouraged to perform your deep breathing, coughing and leg exercises while resting in bed.
- You will need to organise a follow-up appointment following discharge.
- A discharge advice form will be given to you prior to you going home.
Advice following TVT
What to Expect
- You may have a slight blood stained discharge for the first couple of weeks. As healing takes place you may experience some dark spotting as the internal sutures dissolve.
- You may feel fatigued.
- You may need to take some simple analgesia e.g. Panadol for pain or discomfort especially on waking and settling at night.
- You can gradually increase your mobilisation aiming to increase your activity every day.
What to Avoid
- Strenuous activity and heavy lifting for six – eight weeks
- Sexual intercourse for four to six weeks to allow time for healing to take place
- Straining when opening your bowels
- Constipation by eating a diet high in fibre and drinking two litres of fluid a day.
When to notify your doctor
- If your vaginal discharge increase and becomes offensive.
- If you develop a fever (Temperature 38° C).
- If you experience persistent or an increase in pain.
- If you show signs of a Urinary Tract infection:
- Temperature > 38° C
- Passing urine frequently
- Burning and pain when passing urine
- Passing blood when passing urine
Staff of Mater Private Hospital Redland PCU2 and Physiotherapy.
Milliman Care Guidelines 1990–2011.
Mater acknowledges consumer consultation in the development of this patient information.
Last modified 13/11/2015.