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Midurethral tape operations

This operation involves the surgical insertion of a ribbon-like tape, which lies under the middle part of the urethra (water-pipe). Providing support at this part of the urethra helps it to remain closed whenever you cough, laugh or exert yourself, preventing the involuntary release of urine. TVT and TOT are different types of this operation.

A small cut inside the vagina and another tiny cut at the top of each leg are used to put the tape in place. This is usually done with a general anaesthetic (fully asleep) or an injection in the back. The cuts are made in your skin and the tape threaded into place using two needles. Dissolving stitches are used to close the cuts.

About 85% of people are either cured or greatly improved after this procedure. The results are slightly different for TVT and TOT, although each has its advantages. The choice between these two may depend on the individual patient and her preferences.

Who does the operation?

Richard Parkinson specialises in urinary incontinence. He performs both TVT and TOT operations regularly in his NHS practice, with regular audits of results and complications through the BSUG procedure database. 

After the operation

Most times, there is no need for a catheter after the operation. Occasionally a catheter may be left in for a day or two, but this will be discussed with you prior to the operation. Most ladies go home on the same day as the operation, however a few who are uncomfortable or have difficulty passing urine stay over night.

You may experience discomfort in your upper legs. This is usually relieved by mild pain killing tablets.  There may be a little bleeding from the wound edge for 24 hours after the operation. This usually settles without any treatment, but if there is a worrying amount of bleeding you should contact your doctor. The stitches will dissolve. You may notice a few pieces of stitch falling out of your vagina after a week or so as the vaginal stitch gradually dissolves.

  • You will require between 2 to 4 weeks off work. You should avoid any straining which causes discomfort but otherwise no special precautions are required. 
  • You can drive as soon as you can do an emergency stop without pain.
  • Bathing and showering is as usual.
  • Avoid intercourse for about 4 weeks to allow the vagina to heal.

Key points

  • Success rate (dry or much improved) is 85%
     
  • Most patients go home on the same day as their operation.
  • You may have some discomfort or minor bleeding, which usually settles.
  • 2-4 weeks off work are usually required.

Success rates

The TVT operation is designed to cure stress incontinence (leaking with coughing, sneezing, exercise). Published studies indicate success rates of around 85% from these procedures.

There is also sometimes an improvement in associated urgency (a need to reach a toilet urgently.)

  • 50% (50 out of 100) are improved
  • 40% (40 out of 100) are no different
  • 10% (10 out of 100) are worse

The procedure is not used for those with urgency but no stress incontinence.

Possible complications

Fortunately complications from these operations are rare but can occasionally occur.

  • A few ladies find it difficult to empty their bladder on the first day and may need to have a catheter passed to help this. Rarely, patients are unable to pass water at all and must rely on a catheter to empty their bladder. If this does not settle, an operation to divide the tape may be necessary.
  • In a few ladies the flow of urine remains slower than before the operation.
  • About 10% of patients will notice they have to rush to the toilet to pass water (“urgency”) following a tape operation. This may improve over time or may need to be treated with tablets. Very rarely (about 1 in 100) it is so severe that leakage occurs which is as bad or worse than the original stress incontinence.
  • The tape can sometimes be felt through the vaginal skin if the skin does not heal properly. This is rare (less than 1%) but might require an operation to repair the skin. If this is unsuccessful, the tape may need to be removed.The needle can pass into the bladder but this is very rare.
  • There has been some controversy recently surrounding the use of mesh in vaginal surgery. Most of the problems have been with mesh used to treat vaginal prolapse and not with tapes used for incontinence treatments. Further information about the mesh review can be found here: https://www.england.nhs.uk/ourwork/qual-clin-lead/mesh/