THE SURGERY
“Tape rescue surgery”. The operation needs to be performed under spinal anesthesia, as it permits testing for continence during the procedure. With a No18 Foley catheter in place, a vertical incision is made in the vagina from midurethra to within 0.5cm of external meatus, so the external urethral ligament can be accessed for the vaginal part of the procedure, see VIDEO2. The tape is identified. After preliminary dissection, the suburethral loop of the tape is grasped with two fine mosquito forceps and, under tension, divided in the midline. This facilitates further dissection of each side of the tape from its lateral attachments to the urethra. The bladder is filled with 300ml of saline and the patient is asked to cough. The forceps are moved to each edge of the cut tape. They are approximated while the patient is coughing until there is no urine loss, or preferably, a few small drops which are more indicative of the correct tension. Interrupted non-absorbable sutures are placed into both cut edges, but not immediately tied. The catheter is re-inserted and the sutures are tied over the catheter, taking care to avoid excessive tightness. It needs to be remembered that the urethra is elastic and easily compressed*[7,8]. The 18gauge Foley catheter acts as an obturator and prevents over-tightening. The catheter is removed and the patient is re-tested.