The suburethral sling is a new minimally invasive operation performed to correct stress urinary incontinence (SUI). It utilises the concept of providing support for the urethra, as seen with the popular tension-free vaginal tape (TVT) operation, which has been shown to cure SUI in 80 to 90% cases at 7 years follow up. However, in contrast to the TVT operation, the transobturator sling (TOT) is performed with a different approach that is thought to reduce the risk of bladder injury during surgery. The sling used in this operation is made up of polypropylene, the same material used in TVT operations, which have been shown to be very, well tolerated by the body.
What is involved?
The procedure is mainly performed under a short general anaesthetic, and takes about 15-30 minutes. Local or Spinal anaesthesia may be used if required. During the procedure, 2 small incisions will be made at the suprapubic region (TVT) or vulval area (TOT) and another small incision will be made inside the vagina just under the urethra. The sling will be tunnelled between these incisions inside the body. The incisions are then either closed with dissolvable sutures or surgical glue.
There can be a small risk of bleeding (which is rarely severe enough to require blood transfusion), wound infection and injury to surrounding organs (eg. Bladder, bowels). There is also a very small risk of sling rejection or infection, which may require sling removal. A small number of women (3% risk with the TVT operation) may develop difficulty-passing urine following surgery, and this may require the use of a catheter. Some women (7% risk with the TVT operation) can develop bladder overactivity, but this can be treated with pelvic muscle exercises and medication. Anaesthesia is not, without risks; these are outlined in the Ministry of Health consent forms.
Studies have shown it to cure SUI in 86-95% of cases in short term (follow up of up to 12 months) and up to 81.3% (Nilsson et al) at 7 years (TVT). Weight loss if overweight, reducing or quitting smoking, improving pelvic muscle tone by doing pelvic muscle exercises and continuing to do them after surgery will ensure that the operation is a success.
When you go home you must not lift heavy objects (more than 9lbs or 4kgs) or do strenuous work for about 6 weeks. Avoid intercourse for the same period. You can return to work usually in ten to fourteen days (10-14 days).
You will be seen in either the clinic or at urodynamics 6 to 8 weeks after the operation. If everything is well the success of your operation should be permanent.
Post Operative Instructions:
You will have some vaginal discharge for 4 to 6 weeks. This should be light bleeding or spotting only, and this may vary during that period of time as healing occurs and your stitches dissolve.
Pain should be relieved with Panadol, Tramal or Ponstan, Constipation should be avoided, so ensure you have an adequate intake of fibre and fluids in your diet).
Do not use tampons, pads are better.
Do not drive an automatic car for: 1 week
Do not drive a manual car for: 2 weeks
Do not make a bed for: 2 weeks
Do not hang out washing for: 4 weeks
Do not use your Vaginal Oestrogen for 4 weeks
Do not stretch upward for: 6 weeks
Do not lift anything over 4kg for: 6 weeks
Do not have sexual intercourse for: 6 weeks
The first week is the most important, where one must rest.
You may experience for up to 72 hours:
• Urinary frequency
• Dysuria (burning and stinging sensation when you pass urine)
• Haematuria (blood stained urine)
Remember when emptying your bladder, sit on the toilet, feet flat and lean forwards. Drink 6 – 8 glasses of fluid per day; limit your caffeinated drinks to 3 per day, and take Ural (for the frequency and dysuria) if required.
You will be sent a follow up appointment 6 to 8 weeks after surgery; if you have any queries during this time please contact Dr Aruku or the Urogynae Nurse or his registrar at the telephone number provided on the front page.
Contact your G.P or your local hospital if you experience any of the following: You can see the Registrar in ward IC (Gynae ward) if in real emergency.• You cannot pass urine
• You have severe pain or bleeding
• You develop a fever
• You have unusual vaginal discharge or odour
• You have heavy vaginal bleeding or clotting
Your doctor will be happy to discuss any concerns that you may have regarding this operation.
I have read this information leaflet and understand its content.
PLEASE BRING THIS LEAFLET WITH YOU AT THE TIME OF ADMISSION FOR YOUR OPERATION (TVT, MONARC, I-STOP, IVS)
Patient Information Leaflet
Dr ARUKU NAIDU
CONSULTANT O & G and UROGYNAECOLOGIST
IPOH SPECIALIST HOSPITAL