Urinary incontinence affects approximately one out of every five adult women in the United Kingdom, and is more prevalent than diabetes, hypertension, or depression. There are three main types of urinary incontinence, but stress incontinence, is the most common type of incontinence and accounts for roughly 75% of all urinary incontinence.
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It can occur in any stage throughout a women's life: college; university; pregnancy; following childbirth; and on into menopause. This condition results from a weakening of the pelvic supportive structures for the bladder, bladder neck and urethra, which can be caused by pregnancy, childbirth, obesity and prior pelvic surgery.
The mainstay of treatment for significant stress urinary incontinence is surgery. However, surgery for stress incontinence of urine has changed markedly over the last 15 years through the introduction of the tension free vaginal tape known at the TVT. The TVT is a simplification of technique that has been used for a century; the placement of a sling underneath the urethra (the tube leading from the bladder for passing urine) to support the urethra when you cough, laugh sneeze or exert yourself in any way.
The big advance with the TVT is that the sling is inserted through a small vaginal incision and two very small supra-pubic incisions. The procedure is most commonly performed under general or spinal anaesthesia and usually involves no more than 24 hours in hospital. Most patients are able to return to normal activities and work within two weeks. Trials have shown that the TVT is as effective as previous procedures but the recovery time is faster.
Since the TVT was introduced modifications have been developed. The most important development is called the transobturator tape or the TOT/TVT-O because it is introduced in a different way. Early follow up studies have shown that it is as effective as the TVT but long term data is awaited.
The diagrams illustrate the placement of the two types of tapes.
TOT / TVT-0
A special bladder investigation called urodynamics needs to be undertaken before surgery so that the diagnosis is confirmed prior to the TVT procedure.
Genito-urinary prolapse and urinary incontinence (pelvic floor disorders) is a very specialist area. Consultant gynaecologists and urologists across the north-west refer women with these specific problems to Manchester-based uro-gynaecologist Dr Anthony Smith, who has regular clinics at Spire Regency Hospital in Macclesfield.
If you would like to arrange a consultation with Dr Smith, please call our dedicated customer service line on 01625 505 412 or complete the form on the right-hand side of this page.