Mid-Urethral Sling Obturator

This is a newer procedure for urinary stress incontinence. This procedure is performed under general or regional anaesthesia. A small incision is made in the vagina and the permanent tape is introduced via the vagina to sit under the urethra. The trocars used to introduce the tape are removed through small incisions at both sides of your upper inner thigh (see picture). Success rates up to 5 years following the surgery are in the order of 80-85%. The tape used is a permanent mesh, which will not be dissolved by your body. This type of mesh is frequently used by surgeons in hernia repairs.

Transobturator Tape Diagram

Risks and complications

Serious complications are rare with this type of surgery. However, no surgery is without risk and the main potential complications are listed below.

      • 10-15% failure rate
      • 1-5% voiding difficulties necessitating self-catheterisation after the surgery
      • 5-10% bladder irritability (urgency symptoms or overactive bladder) after the surgery
      • This procedure is not aimed at improving any urgency symptoms, which are likely to persist and may deteriorate.
      • 1-5% urinary tract infections
      • very small risk of damage to the bladder, urethra or blood vessels requiring further surgery
      • 1% risk of wound infection
      • 1% risk of blood clots in the legs or chest
      • 1% risk of mesh becoming infected or rejected necessitating the tape removal
      • 2-3% risk of tape erosions into vagina or urethra
      • 2-3% risk of groin pain that can be difficult to treat and may require subsequent surgery

Hospitalisation and recovery

You will be admitted to hospital for 1 day depending on your bladder function after the surgery. You will have a catheter in the bladder after the surgery and this will be removed the next day. If other surgery is performed at the same time you will have a pack in the vagina for the first 24hrs. At home you will recover fairly quickly and will be able to return to light activities after 2 weeks. If you develop symptoms of a urinary tract infection (burning or stinging as you pass urine) you should see your local medical officer. You will be seen in Dr Maher’s clinic 6 weeks after your surgery.

Avoiding heavy lifting (>15kg), weight gain and smoking can minimize failure of the procedure in the long term. If you have any questions about this information, you should speak to Dr. Maher or a doctor of his team before your operation.