The TVT (Tension-free Vaginal Tape) method is used for surgical treatment of stress urinary incontinence in women. It is performed with the vaginal access in order to support the middle and rear part of the urethra.
After administering anaesthesia (usually local or spinal) and entering a Foley catheter, an incision is made at the vaginal wall in the central section, approx. 1-1,5 cm from the external urethral orifice. The length of incision shall be approx. 3 – 4 cm allowing to dissect the central part of urethra and side areas to prepare a tunnel up to a space behind the pubic bone. A needle applicator is inserted into the prepared tunnel and the tape is fed via it. A probe is inserted into the urethra and directed towards the right thigh of the patient. Along the probe the TVT applicator with a fixed urological tape is fed. The applicator is fed approx. 3 cm from the centre line of the patient’s body. When first resistance is felt, the pelvic diaphragm is pierced, and when second resistance is felt the needle is passed through the abdominal fascia. It is brought to the surface via a tiny cut in the abdomen, just above the pubic area. The whole procedure shall be repeated for the opposite side. Then, the bladder is filled, a cystoscope is inserted to check possible damages. After a positive control, the tape endings are removed from the applicator. The cough stress test is carried out to evaluate the tape tensioning and adjust it properly. The endings are cut and stitches are applied on the cuts. The vaginal mucous membrane is sewn with singular absorbable stitches, the wound is disinfected, a dressing is applied. A Foley catheter is inserted into the urethra and left for the first day after the surgery.