The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on transobturator foramen procedures for stress incontinence in January 2005.
This guidance has been withdrawn as the use of this procedure is now covered in the Clinical Guideline on Urinary incontinence: The management of urinary incontinence in women, (www.nice.org.uk/cg40). NICE has no plans to carry out further assessment of this procedure under the Interventional Procedures Programme.
Stress urinary incontinence is the involuntary leakage of urine during exercise or movements such as coughing, sneezing and laughing. It is usually caused by weak or damaged muscles and connective tissues in the pelvic floor, compromising urethral support, or by weakness of the urethral sphincter itself.
Typically, first-line treatment is conservative and includes pelvic floor muscle training, electrical stimulation, biofeedback and mechanical devices (urethral plugs and inserts). If the condition does not improve, surgical alternatives in women may include colposuspension, tension-free vaginal tape (TVT), traditional suburethral slings, and injectable agents. Of these four types of operation, colposuspension and TVT are currently the most common.
Transobturator tape is similar to TVT, but a different technique is used to insert the tape.