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Urinary incontinence - tension-free vaginal tape

Retropubic sling; Obturator sling

Placement of tension-free vaginal tape is surgery to help control stress urinary incontinence. This is urine leakage that happens when you laugh, cough, sneeze, lift things, or exercise. The surgery helps close your urethra and bladder neck. The urethra is the tube that carries urine from the bladder to the outside. The bladder neck is the part of the bladder that connects to the urethra.

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Description

You have either general anesthesia or spinal anesthesia before the surgery starts.

A catheter (tube) is placed in your bladder to drain urine from your bladder.

A small surgical cut (incision) is made inside your vagina. Two small cuts are made in your belly just above the pubic hair line or on the inside of each inner thigh near the groin.

A special man-made (synthetic mesh) tape is passed through the cut inside the vagina. The tape is then positioned under your urethra. One end of the tape is passed through one of the belly incisions or through one of the inner thigh incisions. The other end of the tape is passed through the other belly incision or inner thigh incision.

The doctor then adjusts the tightness (tension) of the tape just enough to support your urethra. This amount of support is why the surgery is called tension-free. If you do not receive general anesthesia, you may be asked to cough. This is to check the tension of the tape.

After the tension is adjusted, the ends of the tape are cut level with the skin at the incisions. The incisions are closed. As you heal, scar tissue that forms at the incisions will hold the tape ends in place so that your urethra is supported.

The surgery takes about 2 hours.

Why the Procedure Is Performed

Tension-free vaginal tape is placed to treat stress incontinence.

Before discussing surgery, your doctor will have you try bladder retraining, Kegel exercises, medicines, or other options. If you tried these and are still having problems with urine leakage, surgery may be your best option.

Risks

Risks of any surgery are:

Risks of this surgery are:

Before the Procedure

Tell your health care provider what medicines you are taking. These include medicines, supplements, or herbs you bought without a prescription.

During the days before the surgery:

On the day of the surgery:

After the Procedure

You will be taken to a recovery room. The nurses will ask you to cough and take deep breaths to help clear your lungs. You may have a catheter in your bladder. This will be removed when you are able to empty your bladder on your own.

You may have gauze packing in the vagina after surgery to help stop bleeding. It is most often removed a few hours after surgery or the next morning if you stay overnight.

You may go home on the same day if there are no problems.

Follow instructions about how to care for yourself after you go home. Keep all follow-up appointments.

Outlook (Prognosis)

Urinary leakage decreases for most women who have this procedure. But you may still have some leakage. This may be because other problems are causing your incontinence. Over time, some or all of the leakage may come back.

Related Information

Anterior vaginal wall repair
Artificial urinary sphincter
Urinary incontinence - injectable implant
Urinary incontinence - retropubic suspension
Urinary incontinence - urethral sling procedures
Stress urinary incontinence
Urge incontinence
Urinary incontinence
Urinary incontinence surgery - female - discharge
When you have urinary incontinence
Kegel exercises - self-care
Urine drainage bags
Self catheterization - female
Suprapubic catheter care
Urinary incontinence products - self-care
Urinary incontinence - what to ask your doctor
Urinary catheters - what to ask your doctor

References

Gomelsky A, Dmochowski RR. Slings: autologous, biologic, synthetic, and midurethral. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 125.

Walters MD, Karram MM. Synthetic midurethral slings for stress urinary incontinence. In: Walters MD, Karram MM, eds. Urogynecology and Reconstructive Pelvic Surgery. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 20.

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Review Date: 1/10/2021  

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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