A transvaginal tape or midurethral sling is a ribbon of tape which is placed under the urethra to provide additional support at times of increased pressure on the bladder, such as coughing, sneezing, straining or laughing. It is the most commonly performed surgery for stress urinary incontinence in women. The tape is made up of polypropylene, a synthetic material which does not become absorbed by the body. It is a minimally invasive procedure which can be performed on a day only basis or a short overnight hospital stay with a fast recovery.
The treatment is beneficial for women who have stress incontinence with leakage of urine due to certain activities such as coughing, sneezing, laughing, lifting or playing sports. It is not recommended for women who may or wish to become pregnant.
The implantation of transvaginal tape takes about 30 minutes and is usually performed under general anaesthesia. The procedure begins with an incision in the vagina beneath the urethra opening. The mesh tape is inserted through the incision in the vagina and positioned underneath the urethra. The tape is then pulled through two tiny incisions in the skin surface, just above the pubic area or in the groins. The tape lies tension-free under the urethra like a hammock and supports the urethra and bladder during straining. Gradually the body tissues grow into the mesh and permanently secure the device in place. It is recommended to avoid heavy lifting, straining, constipation and sexual intercourse for the first six weeks after surgery.
Risks and Complications
The associated post-operative risks and complications include bleeding, infection, post-operative voiding problems such as urinary retention requiring catheterisation or tape division, urinary tract infections, urinary frequency, urgency or urge incontinence. Sometimes erosion of the tape into the bladder or vagina can occur and this may cause haematuria or other urinary symptoms, pelvic pain, discharge and dyspareunia (painful intercourse).