What Is Urinary Stress Incontinence?

Urinary stress incontinence occurs when a woman leaks urine when they exercise, cough, sneeze or laugh. It usually happens because the muscles and tissues that make up the pelvic floor have become weak or damaged. The pelvic floor works like a sling that goes from the pubic bone in the fro to the base of the spine at the back. It supports the urethra which is the tube which carries urine down from the bladder. When the pelvic floor is strong and can keep the urethra in the right position, the urethra can form a tight seal so that urine does not leak out. If the pelvic floor is damaged or weak, it does not support the urethra properly. So when a person moves and there is pressure on the urethra, it moves out of position. The tight seal is lost and urine leaks out.

What Is A Transobturator Tape (TOT) Procedure?

A small incision is made on the wall of the vagina and the permanent tape is introduced via the vagina to sit under the urethra. The needles used to place the tape are introduced through small incisions at both sides of your upper inner thigh (see picture). The tape used is a permanent mesh, which will not be dissolved in your body.

Surgery for stress incontinence aims to give you more control over your bladder. It cannot always cure the problem completely.

What Are The Risks Or Complications?

Serious complications are rare with this type of surgery. However, no surgery is without risk and the potential complications are:

• Bladder irritability (urgency symptoms or overactive bladder) after surgery (5 – 10%).
• Risk of damage to the vagina, bladder, urethra or blood vessels which will require further surgery (2 – 3%).
• Risk of urinary tract infections (1 – 5%).
• Difficulty passing urine, which will require self-catheterisation after the surgery usually for a few weeks (1 – 5%).
• Risk of a wound infection (1%).
• Risk of mesh becoming infected or rejected which would require the tape to be removed (1%).
• Risk of blood clots in the legs or chest (1%).
• This procedure is not aimed at improving any urgency symptoms, which are likely to persist and may deteriorate.
• Small risk of tape eroding into nearby organs e.g. vagina or urethra.
• Small risk of pain in groin or thigh, associated with the tape.
• Risk of bleeding.