(Mid-urethral Sling; Urinary Incontinence Surgery—Tape Procedures; Tension-free Vaginal Tape (TVT) procedure; Transobturator Tape (TOT) Procedure)
Definition
Definition
Urethral suspension is a surgery to reduce or correct stress incontinence in women. The process uses a sling device to support the urethra, the tube that carries urine from the bladder to the outside of the body.
Female Bladder and UrethraCopyright © Nucleus Medical Media, Inc.
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Reasons for Procedure
Reasons for Procedure
Stress incontinence is uncontrolled leaking of urine. Muscles in the pelvis support the bladder and urethra. When these muscles are weakend these structures can fall. This makes it difficult for the urethra to close to prevent urine leakage from the bladder when there is pressure on bladder, like coughing.
This type of stress incontinence surgery inserts a sling to support the urethra. Lifting the urethra makes it easier for the urethra to close when it should to stop urine leakage from the bladder.
Possible Complications
Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have a urethral suspension, your doctor will review a list of possible complications which may include:
- Bleeding
- Infection
- Reactions to anesthesia
- Inability to urinate
- Continued incontinence or recurrence of the problem
- Damage to other nearby organs or blood vessels
- Erosion or loosening of the mesh material used during the procedure
- Pain, such as during sexual intercourse
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
- Smoking
- Drinking
- Chronic disease such as diabetes or obesity
What to Expect
What to Expect
Prior to Procedure
A series of tests will be done to determine the cause of incontinence. Surgery is only considered after other nonsurgical treatments have been tried. The results from the tests may also be used to prepare for surgery.
Leading up to surgery:
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- Arrange for a ride home from the hospital.
- Do not eat or drink anything after midnight the night before.
Anesthesia
The choice of anesthesia will depend on the doctor, your sepcific procedure, your medical history, and your preferences. You may receive one of the following:
- Spinal anesthesia—to numb your lower body but you will be awake.
- General anesthesia—you will be asleep.
- Local anesthesia—medication will numb the specifc areas that are affected. A sedation medication may also be given to help you relax.
Description of Procedure
There are a variety of sling surgeries. Surgeries can vary by the direction or attachment of the sling. The following is a general description of procedure.
Two small incisions will be made in the lower abdomen or upper thighs. A speculum will be inserted into the vagina to access the inner walls. An incision will be made in the front wall of the vagina. A tunnel or path will be made from the vaginal wall to the area below the abdominal/thigh incisions. A synthetic mesh tape or sling device will be inserted through the incision in the vagina. Each end of the sling has a needle. One needle will be placed through the tunnel that was created and passed through to the abdominal/thigh incision. The steps will be repeated for the other side of the sling. This will place the sling just below behind the urethra. Some tests may be done to make sure the urethra is properly supported. This may include a cough test or a scope passed through the urethra. The tape will be adjusted if needed. Once the position is confirmed, the ends of the sling will be trimmed so that they sit just inside the incisions. All the incisions will then be closed with sutures or surgical glue. In the next few months, tissue will form around the mesh to help hold it in place.
Two common surgery options include tension-free vaginal tape (TVT) and transobturator tape (TOT). The main difference between these two surgeries is the path that the needle is moved through to place the mesh. With TVT, the needle passes near the bladder, bowel and blood vessels. With TOT, the needle does not pass as close to these structures which may decrease the risk of complications.
Immediately After Procedure
After surgery, you will be monitored in a recovery room. You will most likely have a catheter in place to drain your urine.
How Long Will It Take?
30-90 minutes
How Much Will It Hurt?
Anesthesia will block pain during the surgery. After surgery, you may experience some pain or soreness. You will be given pain medicine to relieve discomfort.
Average Hospital Stay
You may be able to go home the same day. If complications arise, you may need to remain hospitalized.
Postoperative Care
At the Hospital
The medical team will monitor to make sure urine is passing as expected. Walking is generally encouraged to help promote recovery and decrease risk of certain complications.
During your stay, the hospital staff will take steps to reduce your chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your incisions covered
There are also steps you can take to reduce your chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your healthcare providers to wear gloves or masks
- Not allowing others to touch your incisions
At Home
There will be some activity limits after the procedure. Lifting and strenuous exercise will be limited for 6 weeks.
Call Your Doctor
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision sites
- Pain that you cannot control with the medications you have been given
- Cough, shortness of breath, or chest pain
- Severe nausea or vomiting
- Trouble urinating
- Pain, burning, urgency, or frequency while urinating
If you think you are having an emergency, call for emergency medical services right away.
RESOURCES:
Urology Care Foundation http://www.urologyhealth.org
CANADIAN RESOURCES:
Canadian Urological Association http://www.cua.org
References:
http://intermountainhealthcare.org/ext/Dcmnt?ncid=520693119
Accessed May 27, 2015.
FAQ mid-urethral slings for stress urinary incontinence. Society of Urodynamics Female Pelvic Medicine and Urogenital Reconstruction website. Available at:
http://www.sufuorg.com/docs/news/Patient-FAQs-MUS-for-posting.aspx
Accessed May 27, 2015.
Magon N, Chopra S. Transobturator tape in treatment of stress urinary incontinence: it is time for a new gold standard. N Am Med Sci. 2012 May;4(5):226-230.
Surgical management of urinary incontinence. Urology Care Foundation website. Available at:
http://www.urologyhealth.org/urology/index.cfm?article=33
Updated January 2011. Accessed October 28, 2014.
Surgical mesh. US Food and Drug Administration website. Available at:
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm142636.htm
Updated October 6, 2014. Accessed October 28, 2014.
Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at:
http://www.nafc.org/bladder-bowel-health/types-of-incontinence/stress-incontinence/surgical-treatment-for-female-stress-urinary-incontinence
Accessed October 28, 2014.
Transobturator sling for stress incontinence (Subfascial hammock). International Urogynecology Associates website. Available at:
http://www.nhs.uk/conditions/Incontinence-urinary/Pages/Treatment-surgical.aspx
Accessed May 5, 2015.
Transobturator tape placement. University of Michigan Von Voigtlander Women’s Hospital website. Available at:
http://www.med.umich.edu/1libr/Gyn/TOT.pdf
Published April 15, 2015. Accessed May 5, 2015.
Urinary incontinence—surgery and procedures. NHS Choices website. Available at:
http://www.nhs.uk/conditions/Incontinence-urinary/Pages/Treatment-surgical.aspx
Accessed May 5, 2015.
Zugor V, et al. TVT vs. TOT: a comparison in terms of continence results, complications and quality of life after a median follow-up of 48 months. Int Urol Nephrol. 2010 Dec;42(4):915-20.
6/3/2011 DynaMed’s Systematic Literature Surveillance
http://www.ebscohost.com/dynamed:
Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last Updated: 5/18/2015