Transobturator foramen procedures for stress urinary incontinence

NICE's guidance on use of this procedure is contained in the Clinical Guideline Urinary incontinence: the management of urinary incontinence in women www.nice.org.uk/cg40. The Institute has no plans to carry out further assessment of this procedure under the Interventional Procedures Programme.

It replaces the previous guidance on ' transobturator foramen procedures for stress incontinence' (Interventional Procedures Guidance no. 107, January 2005). This guidance was withdrawn when NICE was made aware that one of the main studies that was considered in the overview of evidence on the safety and efficacy of this procedure hadbeen withdrawn by the Journal that published it.

Further recommendations have been made as part of the clinical guideline on Urinary incontinence published in October 2006. Clinical and cost-effectiveness evidence was reviewed in the development of this guideline which has led to this more specific recommendation. The IP guidance on transobturator foramen procedures for stress urinary incontinence remains current, and should be read in conjunction with the clinical guideline.

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.

Other (see guidance)

Surgical procedures
Urogenital

Obstetrics and gynaecology
Urology

Interventional Procedures Programme
National Institute for Health and Clinical Excellence
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