Answering Incontinence Community Questions - After a TVT Operation; Mesh Erosion

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TVT Operation - Reader's Question: What can I expect after a TVT operation, in terms of pain, suture removal, voiding and sexual activity?

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TVT is short for Transvaginal tape and is a brand name for a type of sling called a midurethral sling.   There are many products like this on the market and the type of sling you have performed is often at the discretion of your surgeon.   We all have our favorite.

As far as the amount of pain you will have post-op will vary because people have different tolerances to pain, but in general I usually advise my patients that they should take two weeks off of work, but should be feeling pretty good after that.   Because of the minimally invasive nature of this procedure, you will need to really limit your activities for six to eight weeks. That means no lifting over ten pounds, limited bending and stretching and nothing in the vagina for 6-8 weeks; no tampons, no douching, no sex.

There should be no reason for suture removal.   The sutures should either all be under the skin, or absorbable and will dissolve over a few weeks.

The majority of women have no issues with voiding after the procedure.   It is not unusual for some women to have difficulty voiding in the short term after the surgery and may need to have a catheter or learn to catheterize themselves for a short time.   In general, most women are back to normal voiding patterns by six weeks post-op.   Very rarely does someone have to go back to the operating room to loosen the sling.

Mesh Erosion - Reader's Question: What causes mesh erosion and why are so many women suffering from this?

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Mesh erosion after a midurethral sling is caused by numerous factors.   Erosion into the vaginal is by far the most common location of erosion, and the easiest to treat. The most common reason is from infection and the infection works it way out of the vaginal incision and the mesh erodes.   Another cause is that the vaginal incision wasn't closed appropriately and the mesh healing within the vaginal wall.

Sometimes there is a significant amount of blood that collects within the vaginal wall and causes a disruption of the incision.   For erosion to occur into the vagina, there usually is a reason that the vaginal incision is disrupted.

Erosion into the urethra or into the bladder is a more difficult situation to remedy.   Usually, the tape is placed with too much pressure on the urethra or is misplaced into the bladder in the first place.   Removing and remedying this situation is complex but is not impossible.

The good news is that this doesn't happen very often.   To my knowledge and with my research, erosions are not very common and occur much less than five percent of all women who have had a sling.

Erosion of a sling is not subtle.   The most common symptoms include recurrent bladder or vaginal infections, pain, vaginal discharge, pain with intercourse, or bleeding.   If you have had a sling and have the above mentioned symptoms, you should be re-evaluated by your surgeon.   Hope this helps