TVT – Tension Free Vaginal Tape

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Professor Rudy De Wilde: “Hello, my name is Rudy Leon De Wilde; I’m working as a Professor of Obstetrics and Gynecology in the Northern part of Germany, and I’m very honored that Dr. John Miklos out of Atlanta is here. He has worked in recent years in the field of the tension free vaginal tape. The tension free vaginal tape is a therapy for women with urinary incontinence, and I think the expert should say something about that.”

Dr. John Miklos: “Thank you, Rudy, I appreciate the invitation to speak on TVT. Dr. Ulmsten introduced TVT in 1995 in Sweden; I had the pleasure of going to Sweden in 1998 to learn the operation. It is an outstanding minimally invasive operation for the treatment of stress urinary incontinence with great effectiveness, minimal pain and discomfort, and small incisions of no more than about one-third of an inch. The operation has now been performed worldwide with 150,000 cases with 35,000 cases in the United States. I utilize this operation; I’ve performed approximately 250 of these procedures since 1998 and find it to be an outstanding operation for the treatment of stress urinary incontinence patients in select individuals.”

Professor Rudy De Wilde: “First, a little help, what is stress urinary incontinence?”

Dr. John Miklos: “Essentially, stress urinary incontinence is urinary leakage when a patient exerts pressure on her abdominal region and her pelvic floor so when one coughs, sneezes, or strains urine leakage occurs at the opening of the urethra and it creates a hygienic problem for the patient.” 

Professor Rudy De Wilde: “A word about the operation, do you excise any tissue or is this a minimal invasive operation without excision of tissue?”

Dr. John Miklos: “The operation is so minimally invasive that we excise no tissue. The actual surgical procedure entails only two incisions on the very lowest part of the abdomen right above the pubic hairline. The two incisions are only one-third of an inch and then a single incision in the midline of the vagina right underneath the urethra approximately 2.5 cm or 1 inch.”

Professor Rudy De Wilde: “Then afterwards you bring in some kind of tissue.”

Dr. John Miklos: “Yes, first let me emphasize that the TVT is a sling procedure. If you review the literature there are two outstanding operations for the treatment of stress incontinence. Those two operations are the Burch and the sling operation, make no mistake about it, a TVT is a sling operation but we have been able over the last ten years with the help of our colleagues in Sweden to develop a technique that is so minimally invasive using a Prolene mesh tape that functions as a sling procedure and that literally wraps around the urethra and supports it from the bottom up to the anterior abdominal wall.”

Professor Rudy De Wilde: “So you have to suture it to the abdominal wall?”

Dr. John Miklos: “No, actually the tape is delivered by using long needles from the vagina up to the belly wall and it literally anchors in by almost a Velcro technique. The incisions that are made in the passage of the needle; the needles are only .5 centimeters, roughly 5 mm, the tape is 1.1 cm so as the tape passes through the tissue, the needle makes a small passage and as the tape comes through it spreads out, and grabs the tissue making it secure and does not need any suturing into place.”

Professor Rudy De Wilde: “This really seems minimally invasive. Does the patient need general anesthesia for it?”

Dr. John Miklos: “No, Rudy, as a matter of fact, I have been taught by the doctors who invented the operation and I highly encourage other physicians to stay to protocol, and that is attempt to do the operation either under local anesthesia or regional anesthesia. In other words, the patient must be awake during the operation to get the full effect of the surgical protocol. The patient’s bladder is filled with a certain amount of fluid, they cough, they leak, and you gently adjust the tape so that they no longer have stress urinary incontinence. Over-adjustment obviously allows for possible retention and difficulty in urinating and that’s one of the problems that we see with the standard sling procedure. The TVT has taken away the voiding dysfunction that is often associated with a suburethral sling procedure.”

Professor Rudy De Wilde: “This really seems minimally invasive; you don’t need any general surgery, and you have very small incisions. It seems very good. Have you got any complications?”

Dr. John Miklos: “With approximately 240 patients that I have operated on, I have had 2 patients that went into retention. Six weeks later we simply cut the tape in a second minor operation of only seven minutes, their ten minutes long, and we literally cut the tape, closed this vaginal skin back up with an incision, once again, of only three-fourths of an inch. The patient could void without problem and both patients remain completely continent, meaning they no longer leaked but they could completely empty their bladder immediately following the release of the tape. I have personally had very few other complications, some minor urge incontinence afterwards and on occasion a bladder perforation but a small hole in the bladder with a removable needle will heal on its own without any complications at all.”

Professor Rudy De Wilde: “So to end, a minimal invasive technique for stress urinary incontinence with no major complications. Thank you very much Dr. Miklos out of Atlanta.”

Dr. John Miklos: “Thank you very much, Rudy.”