Stress Incontinence Surgery
Transobturator Tape for Stress Incontinence
This incontinence treatment helps stop leaks that occur when you sneeze, laugh, or cough. Find out if transobturator tape is a good choice for you.
By Marie Suszynski
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Leaking even a little urine can have a big impact on your life. Some women with stress incontinence are so afraid of experiencing leaks at the wrong time that they avoid traveling, playing with their kids, or even laughing.
Get ready to giggle again: There’s a minimally invasive surgical procedure that can dramatically improve symptoms of stress incontinence. It’s called transobturator tape, or TOT. With a high success rate and a quick recovery time, this treatment is a good option for women who have stress incontinence.
How Transobturator Tape Works
When you have stress incontinence, urine can leak out of your bladder when there is an increase in pressure on your belly, such as when you bend over, lift an object, cough, sneeze, exercise, have sex, or laugh, says Adam S. Holzberg, DO, a urogynecologist and co-division head of Female Pelvic Medicine and Reconstructive Surgery at Cooper University Hospital in Voorhees, N.J.
Normally the urethra, the tube that allows urine to leave the bladder, is held in place by ligaments to keep urine from leaking out of the bladder when there’s stress such as a cough. But sometimes ligaments on the pubic bone can become dislodged and cause hypermobility of the urethra, which leads to stress incontinence, says R. Carrington Mason, DO, a urologist at Methodist Dallas Medical Center in Texas.
There are several things that can lead to weakened or displaced pubic bone ligaments and the development of stress incontinence in women, including:
- Giving birth, vaginally or by Caesarean section
- Having a chronic cough from being a smoker
- Having a job that involves heavy lifting and straining
Aging also contributes to stress incontinence, and there is a genetic component as well, Dr. Holzberg says.
Insertion of transobturator tape or a transobturator sling provides a supportive backboard for the urethra and helps to prevent the bladder from leaking urine, Holzberg says.
Transobturator Tape: Pros and Cons
There are several reasons TOT may be a good choice for you if you have stress incontinence.
Pros:TOT is an outpatient procedure, involving only 3 small incisions in the vaginal and groin area, so it doesn’t require a stay in the hospital. It only takes five to seven minutes to perform the procedure, Dr. Mason says. Patients are back to their normal activities in 48 hours.
TOT also has a high success rate. Holzberg says that 85 to 90 percent of the time, patients will see a significant improvement in symptoms. Although they may not stop leaking urine completely, women who have the procedure see dramatic improvements in their quality of life.
Mason says that about 92 percent of the women who have received the procedure in his office were able to maintain bladder control normally afterward without having to use pads.
Another reason to consider a TOT: Other treatments are limited for stress incontinence, although there are behavioral therapies that can help.
Cons:Although the risk is low, there is always a chance of complications. The procedure could result in a bladder injury or an infection of the bladder, Holzberg says. The procedure may also cause an increase in the urge to urinate and the frequency of urination.
There’s also a risk that the surgeon will make the tape or sling either too tight or too loose, Mason says. It could be so tight that you won’t be able to urinate at all. However, that situation can be fixed easily.
Are You a Candidate for Transobturator Tape?
Anyone with stress incontinence is a candidate for the procedure, Holzberg says. Your urologist can confirm the diagnosis with tests.
“We don’t necessarily tell patients they need it,” Holzberg says. But if your quality of life is being compromised, TOT may be worth considering. And age doesn’t matter. Mason has performed the procedure on women in their twenties and in their nineties.
Many women are so embarrassed by stress incontinence that they don’t tell even their doctor how bad their symptoms are until after they’ve received incontinence treatment.
But it’s good to know that there is a procedure that can give you the confidence to run around the yard with your kids, stay in shape with exercise, and laugh to your heart’s content.
Video: Transvaginal removal of synthetic midurethral sling (Graphic)
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