In the not-so-distant past, women suffering from stress urinary incontinence were treated with a bladder tack, a procedure which was a "big deal," explains Mark DeGuenther, MD, urologist with Urology Centers of Alabama. Now with an obturator tension-free vaginal tape, treatment is improved and the recovery is much easier. "It's a very minor outpatient surgical procedure. I've been more excited about the results with this procedure and the easy recovery than anything I've learned to do any time recently," he says. "The patients have very little recovery period, very little post-operative urinary symptoms, and about 90 percent of the people are either dramatically improved or cured. That is on par with anything else we can do. It's a fantastic procedure."
The old vaginal sling required an incision in the belly, a cut through the fascia, and a big incision in the vagina. "You had to place it in the proper spot and make sure you tacked it down properly. Then you had to fool with getting the tension just right … too much tension and they couldn't void, not enough tension and they still leaked. There was an awful lot of educated guesswork involved," says DeGuenther.
That procedure had evolved to a tension-free vaginal tape that was placed around the urethra. It also required an incision in the vagina, with two stab wounds in the lower abdomen. "It also creates some potential risk because you are passing through an area in front of the bladder where there's an awful lot of big blood vessels," he says.
Now, however, there's the obturator tension-free tape. "It's the same type of approach, but we don't go behind the bladder. We go out to the side and through the obturator foramen. We pass the tape through there and avoid the potential for bleeding in the retropubic veins. It's a significant improvement," he explains.
The procedure takes only 20 minutes, and 85 percent of patients go home without a catheter. There's significantly less postoperative pain and fewer complications as well. "Many women remember when their mother had a bladder tack done. Their mother was in the hospital for five to seven days and had to wear a catheter for two or three weeks, and she did fine for a year or two and then she started leaking again," says DeGuenther. "This is a totally different animal."
Still, there are risks with any procedure. "I tell my patients that they're not going to die or have any significant health problems from stress urinary incontinence. This is purely a quality of life issue. If this is interfering with your quality of life and you want to have something done about it, then we can fix it," he says. "We used to withhold treatment from older women because it was such a big deal. Now it's not so major, so it opens the door for all."
