What surgical treatments are available for stress incontinence?

If the incontinence is thought to be related to prolapse, vaginal repair surgery (6) will improve the problem in about 80% of patients.

Some surgeons, particularly bladder specialists, may operate through the abdomen rather than the vagina. Stitches are introduced to either side of the urethra and attached to the ligaments or bone at the front of the pelvis (colposuspension).

Injections of inert substances can be introduced under the bladder neck. Although with training they are said to be simple to introduce, they are not quite so simple to remove should there be problems. If there is true incontinence associated with a hole in the system (fistula) aurologist (bladder specialist) is likely to be able to close this defect.

For many years a variety of meshes have been introduced under the urethra with varying degrees of success.

In the late 90s a simple technique - tension free vaginal tape (TVT) was introduced. A small incision is made under the urethra and the tape is inserted. Some surgeons perform the operation under local anaesthetic. Usually, you can go home the same day.

More recently, some urogynaecologists have placed the tape through the obturator foramen. Transobturator tape( TOT for short) is similar to an operation called tension-free vaginal tape (TVT). But the way the tape is put in and fitted is different in TOT. This may make TOT safer because there is less chance that your bowel or blood vessels will be injured. 

Success rates in the order of 85% have been quoted for TVT and TOT.0701

In one study,0805 the risk ratio of repeat surgery was 2.6 (95% CI 0.9-9.3) times higher in the transobturator tape group compared to transvaginal tape. It was concluded that retropubic TVT is a more effective operation than the transobturator tape sling in women with urodynamic stress incontinence and intrinsic sphincter deficiency.

After 5, 7 and 10 years of follow up, success rates of 80% are reported.0803, 0804 TVT significantly improves the overall sex lives of women with stress urinary incontinence.

Sexual satisfaction seems to be improved by successful surgery for stress incontinence of urine. Orgasm incontinence, penetration incontinence, post-coital infections, anxiety, and avoidance of sex are all reduced.0802

Complications of Transvaginal tapes

Clinicians should receive specialized training for the transvaginal placement of mesh products and be vigilant for adverse events, the US Food and Drug Administration (FDA) warned on 20th October 2008 in a news release.

Though rare, complications associated with surgical mesh treatment of pelvic organ prolapse and stress urinary incontinence can have serious consequences. During the last 3 years, 9 surgical mesh manufacturers have submitted more than 1000 reports of complications that have included erosion through vaginal epithelium, infection, pain, urinary problems, and recurrence of prolapse and/or incontinence. 0801


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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.

Answers to FAQs on women's health, patient information and medical advice by David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist (Gynecologist - OBGYN), Department of Obstetrics and Gynaecology,

Urinary Incontinence

The aim of this web site is to provide a general guide and it is not intended as a substitute for a consultation with an appropriate specialist in respect of individual care and treatment.

David Viniker retired from active clinical practice in 2012.
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