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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.

Description

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

  • With general anesthesia, you are asleep and feel no pain.
  • With spinal anesthesia, you are awake, but from the waist down, you are numb and feel no pain.

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:

  • Bleeding
  • Breathing problems
  • Infection in the surgical cut or the cut opens up
  • Blood clots in the legs
  • Other infection

Risks of this surgery are:

  • Injury to nearby organs - Changes in the vagina (prolapsed vagina, in which the vagina is not in the proper place).
  • Damage to the urethra, bladder, or vagina.
  • Erosion of the tape into surrounding normal tissues (urethra or vagina).
  • Fistula (abnormal passage) between the bladder or urethra and vagina.
  • Irritable bladder, causing the need to urinate more often.
  • It may become harder to empty your bladder, and you may need to use a catheter. This may require additional surgery.
  • Pubic bone pain.
  • Urine leakage may get worse.
  • You may have a reaction to the synthetic tape.
  • Pain with intercourse.

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:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
  • Arrange for a ride home and make sure you will have enough help when you get there.

On the day of the surgery:

  • You will likely be asked not to drink or eat anything for 6 to 12 hours before the procedure.
  • Take the medicines you were told to take with a small sip of water.
  • Your provider will tell you when to arrive at the hospital. Be sure to arrive on time.

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.

Open References

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.

Lentz GM, Miller JL. Lower urinary tract function and disorders: physiology of micturition, voiding dysfunction, urinary incontinence, urinary tract infections, and painful bladder syndrome. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 21.

  • Urinary incontinence

    Animation

    •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

  • Urinary incontinence

    Animation

    •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

 

Review Date: 1/1/2023

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 C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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