The tension-free vaginal tape (TVT) procedure for stress urinary incontinence is mechanistically based on which concept?

• A Periurethral compression increasing urethral closing pressure at rest
• B Bladder neck elevation by attachment to Cooper's ligament
• C Restoring mid-urethral support via pubourethral ligament reconstruction (integral theory) ✓
• D Complete urethral obstruction to prevent stress leakage

Explanation

TVT is based on the integral theory (Petros and Ulmsten): the pubourethral ligaments at the mid-urethra are key support structures for dynamic kinking of the urethra during raised abdominal pressure. TVT places a polypropylene mesh sling under the mid-urethra to restore this support. Burch colposuspension elevates the bladder neck (Cooper's ligament attachment). TVT is not designed to obstruct the urethra at rest.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.