Urethral Suspension—Tension-Free Vaginal Tape Procedure
Stress incontinence]]> is one of the many causes of uncontrolled leaking of urine. Urethral suspension is a surgery to correct incontinence in women.
The incontinence is most often caused by weakening of the pelvic muscles that normally keep the bladder in position. The muscles may be weakened by:
Female Bladder and Urethra
Reasons for Procedure
The goal of this surgery is to provide extra support to the urethra and give more resistance against leakage. This will stop the uncontrolled leaking of urine.
Complications are rare, but no procedure is completely free of risk. If you are planning to have a urethral suspension, your doctor will review a list of possible complications which may include:
- Reactions to anesthesia
- Inability to urinate
- Continued incontinence or recurrence of the problem
- Damage to other nearby organs or blood vessels
- Erosion of the mesh material used during the procedure
- Pain (eg, during sexual intercourse)
Your overall health will determine if you are at risk for complications. Talk to your doctor about any factors that may increase your risk.
What to Expect
Prior to Procedure
Your doctor will try to find out why you are leaking urine through some or all of the following:
- Medical history—information about medicines, illnesses, number of pregnancies, and previous surgeries; pattern of leaking and how it is affecting your life
- Urine sample—to look for the presence of infection or other problems
- Physical exam—includes a rectal and vaginal exam
Additional testing may be ordered to evaluate bladder function and urine flow, such as:
- Urodynamic testing (urine flow studies)—a temporary catheter is placed to study bladder function
- Cystoscopy]]>—a procedure done to view the inside of the bladder
Leading up to surgery:
- Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Arrange for a ride home from the hospital.
- Do not eat or drink anything after midnight the night before.
Description of Procedure
Two incisions will be made in the vagina. A nylon mesh-like tape will be inserted in these incisions to form a hammock. This will give support to the urethra, closing the urethra during a cough or sneeze. No sutures will be needed to hold the tape in place. The mesh will hold onto the surrounding tissue until scar tissue grows into it.
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?
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.
At the Hospital
At first, your urine may look bloody. This will resolve over time. When you are able to empty your bladder completely, the catheter will be removed. You may be up and walking the same day as the surgery.
Avoid lifting and strenuous exercise for six weeks after surgery. This will allow healing to take place.
To help ensure a smooth recovery, follow your doctor's instructions.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- 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 medicines you have been given
- Cough, shortness of breath, or chest pain
- Severe nausea or vomiting
- Trouble urinating
- Pain, burning, urgency, or frequency while urinating
National Kidney and Urologic Diseases Clearinghouse
The Canadian Continence Foundation
Canadian Urological Association
Surgeries for female stress incontinence. US National Library of Medicine, Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/print/ency/article/002992.htm. Updated May 2008. Accessed October 20, 2009.
The surgical management of female stress urinary incontinence. The American Urological Association website. Available at: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/fsuimainrpt.pdf. Published 1997. Accessed October 20, 2009.
Surgical management of urinary incontinence. American Urological Association website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=03&topic=133. Updated 2003. Accessed October 20, 2009.
Surgical mesh. US Food and Drug Administration website. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm142636.htm. Updated October 8, 2009. Accessed October 20, 2009.
Surgical treatment for female stress urinary incontinence. National Association for Continence website. Available at: http://www.nafc.org/bladder-bowel-health/types-of-incontinence/stress-incontinence/surgical-treatment-for-female-stress-urinary-incontinence/. Updated July 2009. Accessed October 20, 2009.
Treatment and prevention. The American Urogynecologic Society website. Available at: http://www.mypelvichealth.org/TreatmentPrevention/BladderControlProblems/TreatmentOptions/Surgery/tabid/120/Default.aspx. Accessed October 20, 2009.
Townsend MK, Danforth KN, Rosner B, Curhan GC, Resnick NM, Grodstein F. Physical activity and incident urinary incontinence in middle-aged women. J Urol. 2008;179:1012-1016; discussion 1016-1017.
Wein AJ. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Elsevier Saunders; 2007.
Last reviewed October 2009 by ]]>Adrienne Carmack, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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