A Surgical Approach to Stress Urinary Incontinence
Stress urinary incontinence is one of the health problems that can be most challenging in daily life and can affect a person’s social life, self-confidence, and relationships. It presents as involuntary urine leakage during ordinary activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, going up/down stairs, running, or lifting heavy objects.
It is more common than is generally assumed; however, many people avoid seeking help because they feel embarrassed, think it is normal, or believe there is no solution.
Yet stress urinary incontinence is definitely a treatable condition. Among the treatment options, the Retropubic Sling (TVT – Tension-Free Vaginal Tape) is one of the most frequently performed surgical methods worldwide today, with effectiveness proven over many years.
In this comprehensive guide, you can read what TVT is, who it is suitable for, the surgical process, its success, potential risks, and the recovery period—presented in a patient-friendly but scientifically grounded language, reflecting the shared perspective of clinical practice. However, it should be remembered that in a lady with urinary incontinence, the first choice should always be non-surgical solutions such as lifestyle modifications and Kegel exercises. In cases where these solutions do not yield results, surgery will come onto our agenda as the next step in treatment.
What Is Stress Urinary Incontinence?
Stress urinary incontinence occurs due to weakening of the ligaments that support the bladder neck and the urinary passage (urethra), as well as the pelvic floor muscles. When intra-abdominal pressure increases with daily movements, the urethra cannot close sufficiently and urine leaks out involuntarily. In advanced cases, this leakage may even progress to a “squirting” type of leakage.
Main factors that can contribute to or worsen this condition include:
- Vaginal deliveries (especially after the second)
- A high number of pregnancies
- Progressive weakening of the pelvic floor over time
- Chronic constipation
- Jobs requiring continuous heavy lifting
- Obesity
- Smoking and chronic cough
- Postmenopausal tissue weakening, particularly due to estrogen deficiency
- Prior pelvic surgeries
This condition typically worsens over time. The person increases pad use, withdraws from social environments, and performance at work declines. However, with proper evaluation and treatment, high success rates can be achieved.
What Is TVT (Tension-Free Vaginal Tape)?
TVT is the retropubic approach of the midurethral sling method (a tape/band [mesh] placed under the urethra) used in the surgical treatment of urinary incontinence.
In this method, a thin polypropylene tape (mesh) is placed just beneath the urethra like a “hammock” and brought out through small incisions in the groin region. In this way, the tape provides support to the urethra during daily activities.
This support activates continence; the tape does not tightly close the urethra—it only engages when needed. This is where the term “tension-free” comes from: the tape is placed without applying excessive pressure on the tissues.
With nearly 25 years of use, TVT is a method with strong and well-known long-term outcomes.
For Whom Is TVT an Appropriate Treatment?
TVT is performed in patients who have a diagnosis of stress urinary incontinence only and/or predominantly.
People with the following characteristics may be suitable candidates for TVT:
- Those who leak urine while coughing, sneezing, or laughing
- Those who leak urine during sports/exercise
- Those who do not benefit sufficiently from lifestyle modifications and pelvic floor (Kegel) exercises, physiotherapy, or lifestyle changes
- Those in whom stress incontinence is confirmed on urodynamic testing
- Those whose daily life is significantly affected
In some situations, TVT may not be suitable:
- Those in whom urge-type urinary incontinence is predominant
- Those with an active urinary tract infection
- Those with severe pelvic organ prolapse
- Those with neurogenic bladder problems
Therefore, an accurate diagnosis is very important. In Ankara, some specialized clinics create individualized treatment planning by performing both gynecological examination and urological evaluation together prior to TVT.
How Is TVT Surgery Performed?
There may be minor technical differences between centers; however, the method is generally performed with the following steps:
Preoperative Preparation
- Detailed patient history
- Pelvic examination
- Urinalysis
- Urodynamic testing if necessary
- Treatment of infection if present
- Adjustment of blood-thinning medications
The surgical process, recovery period, and possible risks are explained to the patient in clear language.
The Surgical Procedure
- Anesthesia
Spinal anesthesia (numbing from the waist down) or general anesthesia is usually preferred. - Vaginal incision
A small incision of a few centimeters is made in the area under the urethra. - Placement of the tape
The tape is introduced through this incision and guided with the help of small needles behind the pubic bone toward the groins. - Tension-free adjustment
The tape is adjusted so that it is not tight under the urethra. - Bladder check with cystoscopy
After the procedure, the integrity of the bladder walls is checked with a cystoscope. - Closure of incisions
The vaginal incision is closed with absorbable sutures; the tiny groin incisions are closed after the tape ends are brought out.
Duration of Surgery
It takes approximately 25–50 minutes. Patients can often be discharged after a one-night hospital stay.
Recovery After TVT Surgery
Recovery is generally quick and comfortable.
- Mild vaginal soreness and groin pain may occur in the first few days.
- Walking is allowed, but heavy lifting should be avoided.
- Mild bleeding may occur for a few days.
- Most patients return to daily activities within 1 week.
- Sexual intercourse is generally postponed for 6–8 weeks.
- Sports and intensive physical activity require the doctor’s approval.
The most important point is to follow the physician’s recommendations precisely. This increases success rates and reduces possible complications.
Success Rates of TVT Surgery
TVT has been widely performed worldwide for many years in the treatment of stress urinary incontinence. Various clinical series report success rates of up to 90–95%. In our own series, this rate has been reported as approximately 95–97%.
In long-term follow-up:
- The majority of patients state that their urinary incontinence complaints improve substantially even after 10 years.
- Even if recurrent leakage occurs, it is usually mild and can be managed with lifestyle modifications.
Factors influencing success rates:
- The surgeon’s experience
- Proper patient selection
- Adherence to postoperative recommendations
- Management of factors that increase intra-abdominal pressure (such as weight and cough)
In Ankara, specialized centers and urogynecology teams offer strong results both in surgical experience and patient follow-up.
Advantages of TVT Surgery
- Minimally invasive (performed with small incisions)
- Rapid recovery
- Short operative time
- High long-term success rates
- Quick return to daily life
- Supports the pelvic floor in a way closest to natural anatomy
For these reasons, TVT is considered one of the standard surgical methods for stress urinary incontinence today.
Possible Risks of TVT
As with any surgical procedure, TVT has some risks, but these are generally infrequent:
- Temporary difficulty in urination
- Injury to the bladder or urethra
- Temporary urinary tract infection
- Groin pain
- Feeling the tape in the vagina (rare)
- Very rarely, tape erosion
When these complications occur, early evaluation enables prompt solutions. With proper patient selection and an experienced surgeon, complication rates are quite low.
TVT or TOT?
In the surgical treatment of stress urinary incontinence, there are two main commonly used tape methods:
- TVT (Retropubic midurethral sling)
- TOT (Transobturator midurethral sling)
Both aim to support the urinary channel by placing a thin tape beneath the urethra. However, the path they follow in the body is slightly different.
What Is TVT (Retropubic), in Brief?
In TVT, the tape is placed through the vagina and passed behind the pubic bone toward the anterior abdominal wall. In other words, while the tape supports the urethra from below, it extends upward toward the front of the abdomen.
This method may be preferred especially in individuals who:
- Have marked urine leakage when coughing or sneezing,
- Have more clearly weakened tissue support,
- Have jobs requiring heavier physical effort during the day (heavy lifting, high pace).
What Is TOT (Transobturator), in Brief?
In TOT, the tape is again placed through the vagina, but this time it is brought out through lateral openings in the groin region. Thus, the tape supports the urethra more by passing laterally.
In some patients, especially:
- Those with mild-to-moderate stress leakage,
- Those whose pelvic structure and overall condition are more suitable,
TOT can also be an effective and safe option.
Which One Is More Suitable?
There is no rigid division such as “one is good and the other is bad.” Both are surgical approaches that have been used for years and provide good outcomes. To determine the most appropriate method for you, your doctor evaluates together:
- The severity of your complaints,
- Examination findings,
- Urodynamic test results,
- Prior surgeries you have had,
- Your lifestyle and expectations.
In short, there is no single standard answer to the question “TVT or TOT?” The healthiest choice is to decide together with your doctor face-to-face, selecting the method most suitable for your body structure and life.
Frequently Asked Questions (FAQ)
1. Is TVT surgery a permanent solution?
Yes, it is a treatment with strong long-term effectiveness. In the majority of patients, satisfaction continues for years.
2. Is the surgery very painful?
Generally no. Pain is not felt during the surgery; afterward, mild pain may occur for a few days.
3. What is the time to return to work after TVT?
Desk workers can often return within 1 week to 10 days. Those with physically demanding jobs may rest for 3–4 weeks.
4. Does TVT affect sexual life?
Once recovery is complete, it generally has a positive effect. Sexual abstinence for 6–8 weeks is recommended.
5. Will the tape remain in my body permanently? Could it be harmful?
Yes, the tape is permanent, but it is made of a biocompatible material. Except for rare complications, it functions without causing problems.
6. Who performs TVT surgery in Ankara?
Obstetrics and gynecology specialists (especially those working in urogynecology) and some urology specialists perform this surgery.
7. Can TVT be performed for every patient with urinary incontinence?
No. Stress-type leakage must be predominant and must be confirmed through urogynecologic evaluation and examination.
8. What happens if leakage recurs after TVT?
Most of the time it is mild. It can be managed with lifestyle adjustments or additional treatments. Rarely, a second surgery may be required.
Conclusion
The retropubic sling (TVT) is a reliable surgical method with high success rates that has been used for many years in the treatment of stress urinary incontinence. With proper patient selection, appropriate surgical technique, and careful adherence to postoperative recommendations, it is possible both to improve quality of life and to help the patient regain self-confidence in social and working life.
In Ankara, physicians experienced in stress urinary incontinence and urogynecologic surgery—Prof. Dr. Şadıman Kıykaç Altınbaş and Prof. Dr. Ömer Lütfi Tapısız (Gynovart Women’s Health)—provide services as specialists you can consult for modern midurethral sling applications, especially Retropubic Sling (TVT). For information and appointments, you may contact us via our communication page.
