Mid-Urethral Tape (MUT) surgery involves placing a special reinforcement tape (made of prolene which is often used as surgical stitching material). It has become the new “gold standard” operation for treating women with stress urinary incontinence. Essentially it involves inserting a tape made from a special type of plastic under the urethra (small pipe leading from the bladder to the outside world). This acts as a hammock, supporting the bladder and preventing failure of the closure mechanism when you laugh, cough or move suddenly. This tape does not dissolve, but gets incorporated into your body. There are two different approaches for performing the procedure (retropubic and transobturator), and generally both of these are performed under general anaesthetic.
Trans-obturator Mid Urethral Tape
This is quite a similar procedure to the retropubic approach. The tape is inserted through a small incision inside the vagina under the urethra and comes out through two small holes in the groin (the top of the inside of the thigh). This has the advantage that there is less risk of bladder damage (see risks below), but whilst results are just as good as the Retropubic tape, we have less years worth of follow-up because it is a newer technique. These holes are then closed with a dissolvable stitch and heal very well.
What happens after the operation?
After the operation, you may experience nausea and wound pain. Medication will be given to relieve these symptoms. You will normally be allowed to drink and eat on the same day of operation. The urinary catheter will be removed later on the same day or on the next day. The nurse looking after you will make sure you are passing water without a problem and check there is not a large volume of urine left in the bladder after you have finished urinating. A small number of women will not adequately empty their bladders. They may have to go home with a catheter in and come back a week later for removal of the catheter. If a vaginal pack / bandage is used at the time of surgery, it is removed the following day.
There is likely to be some vaginal bleeding after surgery, and this may take a few days to settle down. You are likely to experience pain in the abdomen / pelvis that will require regular painkillers for up to a couple of weeks following surgery. Providing there are no problems you will be allowed home the day after surgery.
Are there any risks?
Both midurethral tape procedures are very safe and effective, but as with any surgical procedure there are risks attached. The risks common to all operations include anaesthetic risks, infection, bleeding, recurrence of symptoms, and formation of a blood clot in the legs/lungs. The main risks specific to the mid-urethral tape procedures are:
- Bladder Damage: This is chiefly a risk of the Retropubic tapes, although can happen with transobturator tapes. Occasionally the needles used to thread the tape can damage the bladder. We put a small camera inside the bladder during the procedure to check for this. If this happens, the tape can be removed, and the operation can normally still be completed. The bladder generally heals very well with no lasting adverse effects.
- Urinary Retention: (Difficulty or failure to pass urine) This is quite common as a temporary problem and means that your catheter may need to stay in place for a couple of weeks. In a very small number of women, (1-2%), the bladder continues to not empty adequately, and women may need to have their mid-urethral tape cut again (which is likely to mean that the stress incontinence returns) or learn to self-catheterise. This latter process involves passing a very fine straw size catheter into the bladder on a daily basis. To reiterate this outcome is extremely uncommon, but every woman needs to be aware of this.
- Urgency: Some women have an element of urgency (needing to rush to the toilet) prior to the operation. For them, this symptom may get marginally better or worse. Occasionally for other women, there may be new symptoms of urgency. This generally only lasts a few months and can be treated with tablets.
- Mesh Erosion: Whilst the tape has been specially designed to sit inside the body, any foreign object can be expelled by the body. This may mean the tape being partially expelled through the vagina, or bladder (in 1-5%of cases). Sometimes this requires no treatment, and in other cases, part of the mesh may need to be removed.
- Chronic Thigh pain: This is only a risk with the transobturator tapes and is rare. It normally resolves after 3 months.
What should I do after the operation?
You should be back on your feet quite quickly, but you avoid heavy lifting for 6 weeks. There may be some bleeding / brown vaginal discharge as the wounds in the vagina heal which is completely normal.
Sexual intercourse may be resumed after 4 weeks if you are feeling comfortable and the discharge has stopped. We generally suggest at least 2 weeks off work.