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Operations: Tension-free urethropexy, Trans-obturator tape (TOT)

Insurance code: M7590

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: This operation is carried out to help urinary incontinence.

Description of procedure: The vaginal skin is opened beneath the urethra and two small incisions are made in the groin alongside the vagina. An introducer is passed from the groins into the vaginal incision carrying a piece of tape which remains tension free. The position of the tape supports the urethra and prevents leakage. The groin and vaginal incisions are closed with single stitches.

Anaesthetic: This operation is usually carried out under a light general anaesthetic.

Length of stay: The length of stay depends on how quickly bladder function returns to normal but an overnight stay is typical.

Post-operative management: Patients will be encouraged to drink freely and pass urine when the bladder feels full. Provided good volumes of urine are passed a catheter assessment of residual volumes is not required.

Potential complications
Complications at the time of surgery include peri-operative bleeding, and damage to structures such as the bladder or urethra. These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn. Early mobilisation and early discharge from hospital reduce the risk of thrombosis. Bladder related complications can occur and include urinary urgency, urge incontinence, incomplete voiding and recurrent urinary tract infections. If incomplete bladder emptying is recognised in the first 48 hours a gentle release of the tape can be carried out under general anaesthetic to make it easier for urine to flow. This is required in 5% of cases. One of the long term complications is rejection of the tape and erosion of the tape into the vagina. This occurs in 3% of cases and usually requires removal of the tape. Leakage often then starts again and a second type of tape can then be inserted in a different direction (tension free vaginal tape).

Post-operative consultation
A routine appointment is normally booked for three weeks or three months following surgery to ensure the operation has been successful and ensure the skin has healed well.

Other considerations
Sex is best avoided until the skin has healed and sutures have dissolved. This operation is now the most frequently carried out surgical procedure for stress incontinence.
Relevant websites

Guidelines on management of urinary incontinence. Requires Adobe acrobat reader.

Good information from the Royal College of Obstetricians and Gynaecologists on surgery for urinary incontinence.