Incontinence & Minimally Invasive Slings
Urinary incontinence affects more than 13 million American women, often as a result of childbirth. While incontinence can be an aspect of aging, the good news is that it can also be cured.
Female stress urinary incontinence generally occurs when the pelvic muscles are not strong enough to keep the opening from the bladder neck closed under increased abdominal pressure. This can be when a woman laughs, lifts, exercises, coughs, walks or sneezes.
A problem with a cure
An excellent method of correcting stress urinary incontinence is to surgically implant a special sling that supports and repositions the bladder neck and urethra so that it can function properly. The end result is that most women are able to regain control of their bladders.
The clinical name for this surgical procedure is a bladder neck suspension ("BNS") and/or a pubovaginal sling. The purpose of these procedures is to create a hammock to support and reposition the bladder and urethra to their normal anatomic position. To accomplish this, a urological surgeon uses a segment of non-absorbable synthetic mesh prepared from the same material as the sutures used in surgery. The goal is always to make the patient continent again.
This kind of surgery may include a stay in the hospital, or it may be performed on an outpatient basis. If you are scheduled for the procedure, you will be informed if there is any special preparation required prior to the day of the surgery. Meanwhile, below is additional information that should be helpful.
What you should know prior to surgery
If required, you will be asked to see your family physician or anesthesiologist for a preoperative check up. If indicated they will do an electrocardiogram, blood work-up, chest x-ray, and urine analysis. These tests are done routinely prior to surgery. Do not take aspirin or any other blood thinning medication two weeks prior to surgery.
Any other medication such as antibiotics, high blood pressure medications, and hormone pills should be continued unless otherwise indicated. Do not eat or drink anything after 11 p.m. the day before surgery.
Any medication that must be taken the morning of surgery should be taken with a small sip of water.
In the hospital or outpatient surgery center
In the preoperative area:
You will be seen by a nurse and an anesthesiologist. They will discuss the details of the pre and post surgery period with you. They will explain the type of anesthesia and the possible risks and complications. An intravenous line will be inserted and a sedative will be introduced into the vein so you will be relaxed prior to surgery. We will also give you intravenous antibiotics prior to surgery. Surgery:
The transobturator vaginal sling is done almost entirely through the vagina. Two very small punctures are made just outside the labia. Because this is not a full thickness incision, it will be closed with a special band-aid and there is less discomfort and more rapid healing. You will have absorbable sutures in the vaginal canal. Risks & Complications
: Complications arising as a result of this surgery are rare but may occur. They include bleeding, infection, accidental injury to the bladder, pain, inability to urinate, recurrent or worsening of incontinence, new appearance or worsening of vaginal prolapse, urgency and urgency type of incontinence, injury to the bowel or to the ureter (the tube that brings urine from the kidneys to the bladder), and vaginal pain and/or narrowing of the vagina. We have not required the use of donated blood in our experience. Therefore, we do not require or suggest that you donate blood prior to surgery.
Following your surgery, the vagina will be packed with antibiotic gauze. Prior to your discharge from the hospital or Surgery Center, the vaginal packing will be removed and the catheter in your bladder will be removed. Because of swelling from the surgery, you may not be able to urinate normally immediately following removal of the urethral catheter. After the swelling subsides, normal urinary patterns will gradually return. Because your normal pattern of urinating will return gradually, there should no cause for alarm should it not occur in the first two weeks after surgery. Until this does occur, it is important to avoid distention of the bladder by limiting your fluids to six to eight 8 oz. glasses per day, and urinating at least every 3 hours. You can resume a normal diet.
You will leave the hospital with a prescription for the following medications:
1. Antibiotic- (Cipro, Levaquin or Bactrim) Take as directed.
2. Pain medication- (Vicodin, Wygesic or Tylenol #3) Take as directed if you experience discomfort. If you experience discomfort not relieved by the medication, please call the office.
3. Stool softener (Colace or Docusate Sodium) is available at any pharmacy over the counter. You may take until you feel your bowel movements are normal. If you experience diarrhea, discontinue the stool softener. If you become constipated, you may use Milk of Magnesia or a Metamucil type preparation.