Patient Information Sheet
MIDURETHRAL SLING OPERATION
TENSION-FREE VAGINAL TAPE (TVT)
TRANSOBTURATOR TAPE (TOT, TVT-O)
What is Stress Urinary Incontinence (SUI)?
Stress urinary incontinence is a condition in which you leak urine on exertion eg.
when you cough, sneeze, jump, run or perform exercises.
What is midurethral tape operation?
It is an operation that is performed for SUI. It works by placing a tape that supports
the middle of urethra (tube from bladder from which urine comes out). There are
mainly 2 types of tapes that could be used for the operation. TVT differs from a TOT
/ TVT-O in that the two skin cuts for the tape are in lower part of your tummy in the
pubic hair area whereas the cuts for the TOT / TVT-O are in the groin (inner side of
the upper thigh). There are no major differences in outcome but the doctor may
prefer one technique over the other when indicated.
Success Rate
Improvement in the frequency and amount of leaking episodes after the procedure is
noted in 82-96% of women after the procedure (National Institute of Clinical
Excellence - patient information 2005). Long term success rate is nearly the same
over the following 10 years. Surgical procedures for stress incontinence are best
deferred if you plan to have children or think you might want to in the future.
How long does the operation take?
The operation usually takes about thirty minutes. However, you will stay in recovery
for monitoring after the operation.
What happens after the operation?
After the operation you will be taken to the recovery room. You may find you have a
mask supplying oxygen and a narrow tube into your vein to give you fluids.
A catheter is sometime left to drain your bladder until you are able to walk to the
toilets.
Most women need to stay in hospital for 1 night until we are sure that they are
passing urine without difficulties. If you have problems passing urine, you may need
to have a catheter for a few days or be taught how to empty your bladder yourself
with a catheter.
Dissolvable stitches or glue may be used for the cuts and usually will not need to be
removed. You may notice a stitch coming away after a few days or you may also get
some vaginal discharge.
You can expect to have some vaginal bleeding for up to a week after your operation.
This is like a light period and is red or brown in colour. You should use sanitary
towels rather than tampons.
What are the risks associated with this procedure?
Complications are not common and include:
 Haemorrhage (excessive bleeding)
 Infection 1%
 1-5% risk of bladder perforations. If this occurs you will have a catheter
inserted and be left for 10 days. We may send you home with the catheter
and make an appointment for you to come to the clinic to have the catheter
removed.
 5% experience difficulty in emptying their bladder. If this occurs you will be
sent home with a catheter and an appointment will be made to have the
catheter removed or you will be taught self catheterisation and reviewed
regularly.
 5 - 10% of women develop the urge to pass urine and frequency after the
procedure. Less commonly they can develop urge incontinence. If you have
pre-existing urgency or urge incontinence, this could get worse.
 6% of women experience urinary tract infections after the procedure and this
can be treated with antibiotics.
 If you develop difficulty in passing urine, or severe urgency that does not
respond to drug therapy, the tape may need to be divided.
 Other rare complications including tape erosion or rejected, bowel, vessel
injury, clots in the leg or pain in the thigh. Rarely the tape might erode into the
urethra. Rarely women complain of altered sensation to the clitoris.
What are the benefits of this treatment compared with other procedures for
SUI?
The benefits of this treatment are:
 Relatively small procedure with a quicker recovery
 little post operative pain
 you will be able to return to normal activities and work sooner
 no large cuts on your tummy
 long term benefits are comparable
TVT / TOT can also be combined with prolapse surgery in which case the recovery
may be longer.
Are there any alternatives to TVT / TOT?

Pelvic floor exercises are usually the first step in managing mild symptoms of
SUI. They can also be effective in preventing incontinence from worsening.
The exercises have to be performed daily and a cure rate of up to 70% may
be expected in mild SUI.
If exercises do not work or cannot be done, surgery will be the next option.

Conventional major surgery (colposuspension) it is done through a larger cut
on your tummy. It may achieve a better short term success rate with
comparable long term success rate, but there is usually a four to six day stay
in hospital and you will need to take six weeks off work.

To inject a bulking agent around the bladder neck. This procedure may be
65% successful at first, but can become less effective (20%) with time and
you may have to have the procedure repeated in nine months to one year.
How will the operation affect my sex life?
In the long term there is no evidence that the operation will make any difference to
your sex life. However if you previously leaked urine during intercourse, the
operation often makes this better.
Activities to avoid
You should avoid:
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Sexual intercourse or using tampons for 4-6 weeks
Constipation/heavy weight lifting to avoid recurrence
Wight gain
Smoking
Douching of the vagina
Any persistent cough needs to be treated promptly
When can I resume work?
Usually within 2 weeks. However if there are ongoing problems contact your GP who
will consider an extension of your sick leave.