midurethral sling

Midurethral Sling

Whatis a "Midurethral Sling"?

The"Midurethral Sling" is a minimally-invasive surgical procedure that isperformed to treat women with "FemaleStress Urinary Incontinence."

Whatis a "Suburethral sling"?

A"Suburethral Sling" is a type of pelvic support that is constructed (surgically) from muscle, ligament, or synthetic material that elevates the bladder from underneath in the treatment of stress incontinence.

Whathappens during "Suburethral Sling" surgery?

InSuburethral Sling surgery, the surgeon inserts a supportive strap of material(called the suburethral sling) which elevates the woman's urethra and bladder neck,and then "anchors" it to each side of her pubic bone.

SuburethralSlings are medical devices made from synthetic material, or they can be fashioned from donor tissue or the patient's own tissue, which is cut fromher abdominal wall. Although it is a more invasive procedure, some patients prefer using their own tissue, because synthetic material may erode into the urinary tract and cause infection or reduce effectiveness.

Newer techniques for SuburethralSling insertion are minimally invasive, allowing for smaller incisions and shorter hospital stays. These techniques are "variations on the suburethralsling and they conceptually work the same way to provide a little hammock for support to theurethra.

Whatis a "Tension Free Vaginal Sling"?

TensionFree Vaginal Sling is a minimally-invasive surgery that provides support forwomen with a sagging urethra. This will help prevent or eliminate theaccidental release of urine when women cough, laugh or move vigorously orsuddenly.

The Tension Free Vaginal Sling procedure uses a mesh or tape that is placedunder a woman's urethra like a sling or hammock to keep the urethra in itsnormal position. The Tension Free Vaginal Sling is inserted through smallincisions in a woman's lower abdomen and vaginal wall. Sutures are not requiredto hold the Tension Free Vaginal Sling in place. Tension Free Vaginal Slingsurgery takes about 30 minutes and may be done under local anesthesia so you cancough when asked by the doctor during the procedure to make sure theTension Free Vaginal Sling is providing the necessary support of your urethra.

Whatis a "Suburethral sling"?

A"Suburethral Sling" is a type of pelvic support that is constructed(surgically) from muscle, ligament, or synthetic material that elevates thebladder from underneath in the treatment of stress incontinence.

Whathappens during "Suburethral Sling" surgery?

InSuburethral Sling surgery, the surgeon inserts a supportive strap of material(called the suburethral sling) which elevates the woman's urethra and bladderneck, and then "anchors" it to each side of her pubic bone.

SuburethralSlings are medical devices made from synthetic material, or they can befashioned from donor tissue or the patient's own tissue, which is cut from herabdominal wall. Although it is a more invasive procedure, some patients preferusing their own tissue, because synthetic material may erode into the urinarytract and cause infection or reduce effectiveness.

Newer techniques for Suburethral Sling insertion are minimally invasive,allowing for smaller incisions and shorter hospital stays. These techniques are"variations on the suburethral sling and they conceptually work the sameway to provide a little hammock for support to the urethra.

Whatis a "Transobturator Sling"?

TheTransobturator Sling is another minimally-invasive surgical procedure that isperformed to help women with Female Stress Urinary Incontinence. The
Transobturator Sling surgery is performed by the doctor placing a narrow stripof tape or mesh in a position that provides support for the woman's urethra. TheTransobturator Sling procedure eliminates some of the potential complicationsthat come about from other Sling type surgical procedures that blindly passes alarge needle carrier through the retropubic space.

What is "Intrinsic Sphincter Deficiency"?

Primarily affecting women, "Intrinsic Sphincter Deficiency" is definedas a weakening of the urethra sphincter muscles.

Asa result of the weakening of the urethra sphincter muscles, the urethra does notfunction normally regardless of the position of the bladder neck or urethra.This condition is a common cause of FemaleStress Urinary Incontinence.

Whatis "Urethral Hypermobility"?

Primarilyaffecting women, "Urethral Hypermobility" is defined as a failure ofthe urethra to close.

What is "Urethropexy"?

Urethropexy is a surgical procedurewhere the support of a woman's urethra is re-supported through sutures thatsurround the urethra's pelvic floor and vaginal tissues to her pubic bone.

What IsSacrocolpopexy?

Sacrocolpopexyis an operation performed from the abdomen to support the vagina to the ligament on the spine (after previous orpresent surgery to remove the uterus) by using a synthetic mesh.

Why IsSacrocolpopexy Performed?

Sacrocolpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of theuterus.

A woman's vagina that has one or more of these vaginal protrusion(s) mayexperience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causespain.
• Difficulty with urination (e.g. unable to completely empty the bladder)
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
• Pain
• Infection
• Bleeding

The objective of the Sacrocolpopexyoperation is to relieve the woman's symptoms and to restore her vagina and hervaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacrocolpopexysurgery?

Sacrocolpopexy surgery is a very common and relatively safe operation withexcellent prognosis and outcomes. However, like any surgical procedure,there are complications which may occur. Possible complications from Sacrocolpopexysurgery may include:

• Bleeding
• Infection
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines)
• Formation of blood clot(s) in the legs or lungs
• Recurrence of problem
• Slow return of bowel or bladder function
• Erosion of synthetic material through vaginal mucosa

What Happens Before SacrocolpopexySurgery?

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health forSacrocolpopexysurgery.

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing.

3. You willbe admitted to the hospital one day before Sacrocolpopexysurgery.

4. You will be given preparations to clear your bowels.

5. Your pubic area will be shaved.

6. You will not be allowed to eat or drink after midnight on the day before the surgery.

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled.

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at leastone week before Sacrocolpopexy surgery.

What happens during the Sacrocolpopexy surgery?

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after theSacrocolpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacrocolpopexy surgery?

1. Immediately after the operation, you mayexperience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities.

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort.

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. Youwill need to wear a menstrual pad during the recovery period, but you will notbe permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You willbe encouraged to move around. Blood chemistries and normal follow-up visits willbe performed.

3. The catheterthat was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery ifthe doctor is pleased with your progress and the outcome of the Sacrocolpopexyprocedure.

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor.

• Using tampons, douching, sexual intercourse and driving for 4 weeks.

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacrocolpopexysurgery.

6. You should (immediately) return to the hospital or notify your doctor if younotic any of the following:

• Heavy vaginal bleeding
• Foul smelling vaginal discharge
• Severe abdominal distension and / or pain not relieved by painkillers
• High fever
• Pain associated with passing urine
• Difficulty in passing urine
• Constipation

Follow-up doctor visits after Sacrocolpopexysurgery

You will be examined by your doctor (at your doctor's office) at approximately;2 weeks, 4 weeks, six months and and one year after Sacrocolpopexysurgery.

It is important to keep your follow-up appointments to ensure the best possible results.

Whatis "Colposuspension" surgery?

Age and vaginal childbirth takes it toll on women's pelvic organs.

"FemaleUrinary Incontinence" is one of the problems most (over 50%) women who havedelivered babies vaginally have to contend with. Women with Female UrinaryIncontinence "leak" urine when they strain, cough, laugh or run.This condition is also called "stress urinary incontinence" meaning the stress of physical activity, not emotionalstress is causing her to "leak" urine.

The problemsassociated with female urinary incontinence are corrected in the the "floor" of thewoman's pelvis by several methods or types of surgeries - one of which is calledColposuspension.

Awoman's pelvic floor is a sheet of special muscles and ligaments that stretch across the inside of thefemale pelvis. Women can feel it "tighten" when they try to hold backthe flow of urine - or when they strain, cough, laugh or run. The uterus andbladder are located above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through thepelvic floor. If the pelvic floor weakens, the uterus and bladder "drop" down. The control of the urine isthereby weakened.

Colposuspensionsurgery strengthens the pelvic floor to lift, or "suspend" the uterus and bladder back upto their correct position within the woman's pelvis

Colposuspensioncomes from the Greek word for vagina - "colpos."

Whatis "Urethropexy"?

Urethropexy is a surgical procedure where the support of a woman's urethra isre-supported through sutures that surround the urethra's pelvic floor and vaginal tissues toher pubic bone.

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