Sling Procedure For Urinary Incontinence

About Retropubic Midurethral Sling/transobturator Midurethral Sling For The Surgical Treatment Of Stress Urinary Incontinence

These operations involve inserting a strip of tape made of a synthetic material to form a sling that supports the urethra . This helps to stop urine from leaking out.

These are performed under a general anaesthetic in the day surgery unit of the hospital, which is currently based in the Addenbrookes Treatment Centre .

Intended benefits

• The aim of this procedure is to cure or improve stress urinary incontinence. This will not improve symptoms of frequency and urgency.
• No operation is guaranteed to cure stress incontinence but these procedures offer a good chance of improving your symptoms. Studies show that 90% of women are cured or have significant improvement after these procedures.

Types Of Sling Procedures For Stress Incontinence

The type of sling procedure best for a woman is assessed by a qualified urogynecologist after careful examination of a patientâs medical history. Some types of sling treatment are better suited for patients than others due to prior existing medical conditions, previous surgical history or severity of incontinence.

The average rest period following surgery differs from patient to patient and by type of procedure. However, most patients are back to normal activity within two to eight weeks. The biggest restriction after surgery is a lifting limit of five pounds. A good benchmark is that a gallon of milk weighs eight pounds, so it is over the weight restriction.

Kinds of sling procedures we offer to treat stress incontinence include the following.

Behavioral Changes As Effective Incontinence Treatments

Patients are encouraged to make several changes to their daily routine that will likely improve their incontinence symptoms including the following.

• Re-training their bladder by waiting to go to the bathroom for about 10 minutes after the urge presents. The patient then slowly increases the amount of time delay before urination, with the goal of urinating every 2-4 hours.
• Double voiding, which is urinating, waiting a minute or so, then trying to empty the bladder once more. This helps to more completely empty the bladder.
• Scheduling urination for preset times rather than waiting for the urge.
• Exercising pelvic floor muscles with Kegel exercises to strengthen muscles that control urination.
• Exercise and healthy eating, patients should try to maintain a healthy weight, exercise, drink fewer fluids, and restrict the intake of alcohol, caffeine and acidic foods.

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Types Of Sling For Incontinence In Females

There are two main types of sling for incontinence in females:

Midurethral sling and Traditional sling

• Midurethral sling: A mid-urethral sling, also known as a TVT sling or tension-free vaginal tape , is designed to help with stress incontinence. It works by repositioning the urethra so that its held up under the bladder rather than letting it sag down inside your body.
• Traditional sling: A traditional sling, or artificial urinary sphincter , works to tighten the muscles around the urethra to prevent incontinence. It can also be used for stress incontinence but is more commonly prescribed for those suffering from complete loss of bladder control.

What Will Happen During Surgery

• You may be given general anesthesia to keep you asleep and free from pain during surgery. You may instead be given local anesthesia to numb the surgery area. With local anesthesia, you may still feel pressure or pushing during surgery, but you should not feel pain.
• Your surgeon will check for correct placement of the sling. A Foley catheter may be placed to help you urinate until swelling from surgery goes away. The incision may be closed with absorbable stitches or medical glue.

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What Happens After The Procedure

After the procedure you may stay in a recovery area for at least a few hours or overnight at the hospital.

You may go home with a catheter, which is a small tube used to drain urine from your bladder. Your healthcare provider will tell you how to take care of the catheter and when it can be removed.

You may have some pain after the procedure. Your healthcare provider may give you pain medicine.

Ask your healthcare provider:

• How long it will take to recover
• What activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup.

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What To Expect The Day Of Your Incontinence Sling Surgery

The day of your surgery, you can generally expect to:

• Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

• Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

• Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.

• A surgical team member will start an IV.

• The anesthesiologist or nurse anesthetist will start your general or regional anesthesia. Your surgeon will perform local anesthesia.

• A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

• A team member will insert a catheter into your bladder to collect urine.

• The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.

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What Can I Expect After My Incontinence Sling Surgery

Knowing what to expect can help make your road to recovery after incontinence sling surgery as smooth as possible.

How long will it take to recover?

You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable.

You will have a tube in your bladder called a catheter when you wake up from surgery. This tube drains urine from your bladder until you have healed enough to urinate normally by yourself. Your catheter will generally stay in place for one day or less, depending on the type of incontinence sling procedure you had.

You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.

You may go home the same day of surgery or stay in the hospital for one to two days, depending on the type of surgery and other factors. Your care team will monitor your healing during this time.

Recovery after surgery is a gradual process. Recovery time varies depending on the type of procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes one to three months.

Your doctor will give you instructions for rest during your recovery. Restrictions generally include:

Will I feel pain?

When should I call my doctor?

Purpose Of The Vaginal Sling Procedure

The vaginal sling procedure is one treatment option for stress urinary incontinence in women. Depending on how severe your urinary incontinence is, your doctor may prescribe other treatment options first. If those treatments dont work, your doctor may recommend the vaginal sling procedure. They may also recommend this procedure if you have a severe case of urinary incontinence and your bladder problems disrupt your everyday life.

The two main types of vaginal slings are conventional slings and tension-free slings.

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Andrada Hamer 2012 Sec

• Andrada Hamer M, Larsson PG, Teleman P, EtenBergquist C, Persson J. One year results of a prospective randomized evaluator blinded multicenter study comparing TVT and TVTSecur . Neurourology & Urodynamics 2012 31:7289.
• Andrada Hamer M, Larsson PG, Teleman P, EtenBergqvist C, Persson J. Shortterm results of a prospective randomized evaluator blinded multicenter study comparing TVT and TVTSecur. International Urogynecology Journal 2011 22:7817.

Important Things You Need To Know

Patient choice is an important part of your care. You have the right to change your mind at any time, even after you have given consent and the procedure has started . If you are having an anaesthetic you will have the opportunity to discuss this with the anaesthetist, unless the urgency of your treatment prevents this.

We will also only carry out the procedure on your consent form unless, in the opinion of the responsible health professional, a further procedure is needed in order to save your life or prevent serious harm to your health. However, there may be procedures you do not wish us to carry out and these can be recorded on the consent form. We are unable to guarantee that a particular person will perform the procedure. However the person undertaking the procedure will have the relevant experience.

All information we hold about you is stored according to the Data Protection Act .

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How Is Incontinence Sling Surgery For Women Performed

Your incontinence sling surgery will be performed in a hospital or surgery clinic. The procedure varies depending on the type of incontinence sling. The sling can be made of tissue from your own body, someone elses body, or from a synthetic material. The surgery generally involves looping the sling under your urethra to provide support and compress it to control urination. Your surgeon then attaches the sling to strong tissues in your lower abdomen.

The Pros & Cons Of Sling Surgery

While scrolling through our comments section on Facebook, we often read statements like: “Just get the sling surgery! Best thing I ever did.” These comments are usually followed up with someone else chiming in to say that “surgery doesn’t work for everybody!” or “it worked for me but only temporarily.” We were stumped. Why did the surgery work for some women while others didn’t have much luck? So of course, learning more about the pros and cons of sling surgery was a no-brainer.

We spoke to Carol and Debbie, two amazing women who were comfortable sharing their bladder surgery stories, as well as Dr. Kimberly Ferrante, a uro-gynecologist from NYU’s Langone Health Center.

When is sling surgery recommended?

Dr. Ferrante says that a urethral sling surgery is done to eliminate stress or mixed incontinence. Stress is the one where you dribble when you cough , laugh , jump, run , skip, dance , ok you get it. While Urge is what makes you feel like you’re going to throttle anyone who’s blocking your path to the restroom.

As Dr. Ferrante emphasized, the sling surgery is for women dealing with stress or mixed. Typically, she says, the surgery is recommended for women who 1) are bothered enough by their leaking that surgery feels like the only other option , and 2) are done babymaking.

Whats the difference between a vaginal sling and mesh?

Ok, now that we’re surgery smart, let’s dive deeper.

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Preparation For The Procedure

Before you have a vaginal sling procedure, tell your surgeon about any medications youre taking. Your surgeon may ask you to stop taking certain medications a few days or hours before your surgery, including medications that thin your blood, such as warfarin, aspirin, and ibuprofen. They may also ask you to avoid eating or drinking anything for six to 12 hours before your surgery.

Be sure to dress in comfortable clothing and arrange for a ride home.

What Is The Male Sling Procedure

In the male sling procedure, synthetic mesh-like surgical tape is positioned around part of the urethral bulb, slightly compressing the urethra and moving it into a new position. The urethra is the tube through which urine exits the body. This procedure helps many patients with urinary incontinence.

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Midurethral Sling Or Tension

A midurethral sling, also known as a tension-free vaginal tape sling, is a small mesh strip used to treat stress urinary incontinence. The sling is made of a polypropylene mesh, which is suture material woven together. Once the sling is in position, over the next 3 to 4 weeks the womanâs tissues will grow and anchor it in position.

The sling prevents leakage by supporting the urethra and mimicking the ligaments that have been weakened by having a child or the aging process. There are three main placements for the sling during surgery: retropubic, transobturator and the single incision sling, or minisling.

If performed on its own, the sling procedure is typically a 30-minute walk-in procedure. If the surgery is done in combination with a prolapse surgery, the patient may be admitted for an overnight hospital stay.

After surgery most patients are able to empty their bladder efficiently, however some may go home with a catheter if there is swelling. In these cases, the woman will then come back 1-2 days later, when the swelling around the urethra has gone down, to have the catheter removed. A woman should be able to drive and participate in usual daily activities a week after surgery.

We advise to avoid heavy lifting and sports for 6 weeks to allow the wounds to heal and the sling to be firmly held in place. We also advise the patient abstain from sexual activity for 8 weeks after the operation.

What Causes Stress Incontinence

The cause of stress incontinence is the weakening of muscle and other tissues that support the bladder and the muscles that regulate the release of urine. Stress incontinence affects up to 1 in 3 women. It can also affect men but is much more common in women. The most common cause of stress incontinence is brought on by childbirth, and one-third of all postpartum women develop symptoms.

Stress incontinence is a type of urinary incontinence, the unintentional loss of urine. Stress incontinence happens when physical movement or activity puts pressure on the bladder causing it to leak. These activities could be sneezing, coughing, heavy lifting or exercising.

Common causes of stress incontinence that can be treated by a sling include:

• Mothers of multiple children and women who gave birth vaginally are at greater risk for stress incontinence than mothers with only one child or when delivery was through surgical means.
• Women highly active in athletic activities requiring long distance running or extended periods of small, sharp impacts, such as running on hard surfaces, jumping repeatedly on a hard surface or heavy weight lifting.
• Aging, menopause or estrogen deficiencies in women, which can thin the urethra and weaken the pelvic floor.
• Injury caused by radiation in cancer treatment.

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Description Of The Condition

Incontinence occurs when this normal relationship between the lower urinary tract components is disrupted, as a result of nerve damage or direct mechanical disruption to the pelvic organs. Advancing age, higher parity, vaginal delivery, obesity and post menopausal status are all associated with an increased risk of urinary incontinence .

There are different forms of urinary incontinence of which SUI is the most common type, accounting for at least 50% of cases of urinary incontinence in women . SUI is the involuntary loss of urine that occurs with physical exertion , or on sneezing or coughing . Urodynamic stress incontinence is the involuntary leakage of urine observed during filling cystometry, it is associated with increased intraabdominal pressure, in the absence of a detrusor contraction . Two mechanisms for stress incontinence are recognized: hypermobility or significant displacement of the urethra and bladder neck during exertion, and intrinsic urethral sphincter deficiency . These mechanisms may coexist in women . Few clinical trials have distinguished between the two conditions, probably because there is currently no standardised and validated test available for this . We considered women whose incontinence could be due to either mechanism together in this review.

Women with MUI who were included in this review had symptoms of SUI plus either urgency or UUI, or urodynamic stress incontinence plus DO .

What Does The Procedure Involve

The male sling is a treatment for male stress urinary incontinence. It involves placement of a synthetic sling that supports the waterpipe . The procedure will involve a cystoscopic examination of the urethra and bladder and an incision in the area behind the scrotum , with two further small cuts in the groin crease.

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How To Choose A Sling For Incontinence In Females

In general, you can choose a sling based on how much control you want to have over your bladder. A mid-urethral sling will give you more control than a traditional sling.

If youre looking for something that will last the longest and require the least number of follow-up visits, then a traditional sling is probably what you want.

In terms of recovery, a traditional sling is the quickest to recover from but may have more post-operative pain and complications than a mid-urethral sling.

On the other hand, a mid-urethral sling takes more time for your body to adjust to it before youll feel full relief from incontinence. But, it may also have fewer post-operative issues than a traditional sling.

Surgery For Female Urinary Incontinence

If behavior modification and pelvic floor exercises dont resolve the symptoms of stress incontinence or are not the preferred primary option for these symptoms, your doctor at NYU Langones Center for Female Pelvic Medicine may recommend surgery, which can cure the condition in most women. There are two main categories of surgery, and the kind thats right for you depends on the type of incontinence and the severity of your symptoms.

Schedule an Appointment

If stress incontinence is so severe that its interfering with your daily life, you may be a good candidate for a surgical treatment. Doctors encourage women to put off surgery until after they are done having children, because additional pregnancies can cause urinary incontinence to return.

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