Urinary Incontinence Surgery—Sling Procedures
(Mid-urethral Sling; Urinary Incontinence Surgery—Tape Procedures; Tension-free Vaginal Tape (TVT) procedure; Transobturator Tape (TOT) Procedure)
Urethral suspension is a surgery to reduce or correct stress incontinence in women. The process uses a sling device to support the urethra, the tube that carries urine from the bladder to the outside of the body.
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Reasons for Procedure
Stress incontinence is uncontrolled leaking of urine. Muscles in the pelvis support the bladder and urethra. When these muscles are weakened these structures can fall. This makes it difficult for the urethra to close to prevent urine leakage from the bladder when there is pressure on bladder, like coughing.
This type of stress incontinence surgery inserts a sling to support the urethra. Lifting the urethra makes it easier for the urethra to close when it should to stop urine leakage from the bladder.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Reactions to anesthesia
- Inability to urinate
- Continued incontinence or recurrence of the problem
- Damage to other nearby organs or blood vessels
- Erosion or loosening of the mesh material used during the procedure
- Pain, such as during sexual intercourse
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:
What to Expect
Prior to Procedure
A series of tests will be done to determine the cause of incontinence. Surgery is only considered after other nonsurgical treatments have been tried. The results from the tests may also be used to prepare for surgery.
Leading up to surgery:
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- Arrange for a ride home from the hospital.
- Do not eat or drink anything after midnight the night before.
The choice of anesthesia will depend on the doctor, your specific procedure, your medical history, and your preferences. You may receive one of the following:
- Spinal anesthesia —to numb your lower body but you will be awake.
- General anesthesia —you will be asleep.
- Local anesthesia—medication will numb the specific areas that are affected. A sedation medication may also be given to help you relax.
Description of Procedure
There are a variety of sling surgeries. Surgeries can vary by the direction or attachment of the sling. The following is a general description of procedure.
Two small incisions will be made in the lower belly or upper thighs. A speculum will be inserted into the vagina to access the inner walls. An incision will be made in the front wall of the vagina. A tunnel or path will be made from the vaginal wall to the area below the belly/thigh incisions. A synthetic mesh tape or sling device will be inserted through the incision in the vagina. Each end of the sling has a needle. One needle will be placed through the tunnel that was created and passed through to the belly/thigh incision. The steps will be repeated for the other side of the sling. This will place the sling just below behind the urethra. Some tests may be done to make sure the urethra is properly supported. This may include a cough test or a scope passed through the urethra. The tape will be adjusted if needed. Once the position is confirmed, the ends of the sling will be trimmed so that they sit just inside the incisions. All the incisions will then be closed with sutures or surgical glue. In the next few months, tissue will form around the mesh to help hold it in place.
Two common surgery options include tension-free vaginal tape (TVT) and transobturator tape (TOT). The main difference between these two surgeries is the path that the needle is moved through to place the mesh. With TVT, the needle passes near the bladder, bowel and blood vessels. With TOT, the needle does not pass as close to these structures which may decrease the risk of complications.
Immediately After Procedure
After surgery, you will be monitored in a recovery room. You will most likely have a catheter in place to drain your urine.
How Long Will It Take?
30 to 90 minutes
How Much Will It Hurt?
Anesthesia will block pain during the surgery. After surgery, you may experience some pain or soreness. You will be given pain medicine to relieve discomfort.
Average Hospital Stay
You may be able to go home the same day. If complications arise, you may need to remain hospitalized.
At the Hospital
The medical team will monitor to make sure urine is passing as expected. Walking is generally encouraged to help promote recovery and decrease risk of certain complications.
Avoid lifting and strenuous exercise for 6 weeks after surgery. This will allow healing to take place. Do not return to sexual activity or use tampons until your doctor says it is okay to do so.
Call Your Doctor
Contact your doctor if your recovery is not progressing as expected or you develop complications such as:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision sites
- Pain that you cannot control with the medications you were given
- Cough, shortness of breath, or chest pain
- Severe nausea or vomiting
- Trouble urinating
- Pain, burning, urgency, or frequency while urinating
If you think you are having an emergency, call for emergency medical services right away.
National Institute of Diabetes and Digestive and Kidney Diseases
Urology Care Foundation
Canadian Urological Association
The Canadian Continence Foundation
Bladder and urethral surgery: TVT and TOT procedures. Intermountain Healthcare website. Available at: https://intermountainhealthcare.org/ext/Dcmnt?ncid=520693039. Accessed December 18, 2020.
Magon N, Chopra S. Transobturator tape in treatment of stress urinary incontinence: it is time for a new gold standard. N Am Med Sci. 2012;4(5):226-230.
Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at: https://www.nafc.org/resource-center/surgical-treatment-for-female-stress-urinary-incontinence. Accessed December 18, 2020.
Transobturator tape placement. University of Michigan website. Available at: http://www.med.umich.edu/1libr/Gyn/TOT.pdf. Accessed December 18, 2020.
Urinary incontinence. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/urinary-incontinence. Accessed December 18, 2020.
Urinary incontinence—surgery and procedures. NHS Choices website. Available at: https://www.nhs.uk/conditions/urinary-incontinence/surgery. Accessed December 18, 2020.
Urogynecologic surgical mesh. US Food & Drug Administration website. Available at: https://www.fda.gov/downloads/medicaldevices/safety/alertsandnotices/ucm262760.pdf. Accessed December 18, 2020.
Zugor V, Labanaris AP, Rezaei-Jafari MR, et al. TVT vs. TOT: a comparison in terms of continence results, complications and quality of life after a median follow-up of 48 months. Int Urol Nephrol. 2010;42(4):915-920.
Last reviewed November 2020 by EBSCO Medical Review Board Adrienne Carmack, MD Last Updated: 11/18/2020