Transobturator tape for stress incontinence

There is a new type of surgical treatment called transobturator tape for stress incontincne, which is used to create a hammock in the same way as an older treatment called tension free vaginal tape (TVT). The new procedure is known medically as TVT-O.

Both treatments support the urethra and help it to close more tightly when the abdominal pressure is raised during coughing or exercising. The tape stays in place permanently.

Fitting a transobturator tape

The procedure takes place under a general or spinal anaesthetic. A small incision (about 2 cm) is made in the vagina just below the opening of the urethra. A polypropylene tape (similar to the material used for surgical sutures) is passed outwards through small (0.5 cm) incisions made in the inner thigh. The tape is positioned without tension under the urethra and acts as a ‘backboard’ to support the urethral continence mechanism (sphincter) when coughing. The incisions are the closed with dissolvable stitches which disappear within 2-3 weeks of surgery. The TVT-O procedure takes about 30 minutes.

How effective is transobturator tape in curing incontinence?

Stress incontinence is common after childbirth with more than one-third of women having some degree of leakage. In these women, TVT-O is effective with over 80% completely dry or much improved after surgery. Most women are able to be as active as they like after the placement of a transobturator tape, for example, lifting children, dancing or exercising. As a result, 18 out of every 20 women are satisfied by the results of the procedure. TVT-O is not a treatment for urge incontinence. In women who have the symptoms of an overactive bladder as well as stress incontinence, secondary anticholinergic medicine or sacral neuromodulation treatment may be required to treat urge symptoms.

What should I expect immediately after the procedure?

When you return to the ward, a catheter is present. This is a tube temporarily draining the bladder. The catheter is usually removed after a few hours. Once you have passed urine, you can leave the ward and go home. This may be the same day, or sometimes the day after the operation. If the operation has been combined with a procedure for prolapse, you will probably be in hospital for a longer period of time. Your stitches will dissolve spontaneously within two to three weeks.

What are the advantages of transobturator tape?

Traditional Tension Free Vaginal Tape (TVT) is designed for the same purpose as Transobturator tape, but is fitted in a different way. During both operations the surgeon places the tape under the middle part of your urethra.

f the surgeon uses the traditional TVT method, the tape ends are passed behind your pubic bone and out through 0.5cm cuts in your abdomen, just above your pubic area. In the TVT-O the tape ends are passed sideways through a natural space in your pelvic bone through small incisions in your inner thigh. This means the surgeon does not go near to the bladder, reducing the risk of damage to the bladder, bowel or blood vessels. There is no need to cut your abdomen.

The traditional TVT tape is passed around the urethra and can cause urethral compression, resulting in voiding difficulty or retention of urine. Since the TVT-O tape is passed laterally below the urethra, the tape is less compressive and the rate of voiding difficulty is significantly lower. The TVT-O tape is placed away from the bladder and causes less bladder irritation and secondary urge (overactive) symptoms, which occur in 10–15% of women after TVT tape placement.

What are the risks and disadvantages of transobturator tape?

One in ten women may experience temporary difficulties in passing urine. This normally improves within a few weeks, but in 1-2% of women, it may be necessary to use an in-out catheter to empty the bladder. In these rare cases, normal voiding is often restored by cutting the tape.

Erosion of the tape into the urethra or bladder can occur in 1-5% of women, months or years after the tape is placed. In these cases the tape will have to be removed.

Urinary tract infection can occur in 1-2% of patients and is treated by antibiotics.

There is a 1-2% risk of nerve damage in the groin.

Worsening of bladder overactivity symptoms can occur in up to 5%, but this can normally be improved with medication.