Stress urinary incontinence in women is an involuntary leakage of urine during tension (for example, exercise), coughing or sneezing. This condition has a very negative effect on the quality of life of patients, as it has not only a medical but also a social aspect. Women do not dare to talk about it with their doctor, because they do not know that there is an effective surgical solution to this problem.
What is sling urethropexy?
Sling urethropexy is the main surgical method of stress urinary incontinence in women. A sling is a mesh polypropylene tape, which is placed around the urethra and fixed. As a result, the urethra is not displaced during exertion and physical exertion, which makes it possible to retain urine.
Depending on the surgical access used to place the sling, there are a posadilone transvaginal sling urethropexy (TVT) and a transobturator sling urethropexy (TVT-O).
Course of operation
The TVT operation is performed as follows: a urethral catheter is inserted into the bladder, then the surgeon makes a small incision on the vaginal wall and two incisions above the pubic bone. The doctor then releases the vaginal wall and urethra from the surrounding tissues. Through the incision on the wall of the vagina, the surgeon can see the bladder, which he gently pushes to the side. Synthetic tape is attached to the metal needle-conductors, through which the tape is pulled behind the urethra, and its tips, passing on both sides of the urethra, are pulled up and out into the suprapubic area. As a result, a prolene tape, like a loop, supports the urethra in the middle part. At the end of the operation, the doctor performs urethrocystoscopy to see if the bladder is damaged. Then the doctor asks the patient to cough and, if the urine continues to leak when coughing, tightens the tape higher. Unnecessary tips of synthetic tape are cut, and the incisions are sutured.
To perform TVT-O, the surgeon only makes an incision in the vaginal wall and two small punctures on the inside of the thighs to reach the obturator holes. After the incision of the anterior wall of the vagina, the surgeon gently identifies surrounding tissue. Then, with the help of special needle-conductors connected to the prolene tape, the surgeon conducts the tape behind the urethra and leads its tips out, but not above the fold (as in TVT), but through obturator openings located in the area of the inguinal fold. This method allows surgeons to better control the path of the needles and to avoid damage to the bladder. At the end of the operation, the doctor also asks the patient to cough and adjusts the grid, if necessary. The incision in the vaginal wall is carefully sutured.
The TVT-O sling urethropexy is an optimal operation since transobturator access minimizes the risk of complications such as bladder damage. After surgery, a catheter is inserted into the bladder. After removing the catheter, the doctor evaluates the patient’s urination and performs uroflowmetry. This is necessary to ensure that the synthetic loop does not compress the urethra and the patient does not have difficulty urinating.
Sling urethropexy is a minimally invasive surgery, so the risk of complications is generally low. Possible complications include bleeding, urinary tract infections, imperative urination, impaired urination, erosion in the area of sling standing.
The operation is performed under general anesthesia but on an outpatient basis, which means that the hospitalization lasts several hours. After surgery, there are no scars. The operation lasts from 10 to 15 minutes and in most cases eliminates the leakage of urine.
Recovery after sling urethropexy occurs quite easily, but some recommendations should be strictly followed. Heavy physical exertion should be avoided within 2-3 months after surgery since at this time the synthetic loop is hardened in its place. Sexual contact should be also avoided within 2-3 months.