The tension-free vaginal tape (TVT) procedure for stress urinary incontinence works by which mechanism?
- A Creating a sling at the bladder neck to elevate it above the levator ani
- B Placing a mid-urethral polypropylene mesh that reinforces the suburethral hammock, enabling urethral kinking and closure during sudden increases in intra-abdominal pressure ✓
- C Tightening the urethrovesical junction by fascial plication (Kelly's suture)
- D Injecting periurethral bulking agents to increase urethral resistance
Correct answer: B. Placing a mid-urethral polypropylene mesh that reinforces the suburethral hammock, enabling urethral kinking and closure during sudden increases in intra-abdominal pressure
Explanation
TVT (tension-free vaginal tape) is based on the integral theory (Petros and Ulmsten, 1990): placing a polypropylene mesh tape at the mid-urethra reinforces the pubourethral ligaments and suburethral supportive hammock. During stress (cough, sneeze), the intact mid-urethral support allows the urethra to kink and close against the tape, preventing urine leakage. It is 'tension-free' because the tape is not anchored under tension — it provides dynamic support. Long-term cure rates exceed 80–85%.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.