There are tests that can be performed to check the bladder, which give a good idea as to the cause of the incontinence.
Leakage with coughing, sneezing and laughing, for example, known as stress incontinence, is caused by a weakness in the outlet valve of the bladder. If physiotherapy is not successful, then surgery may give the best chance of a cure.
There are many different operations for this problem. All have advantages and drawbacks in certain situations, and it is important to choose the best operation for each individual. An important consideration is to balance effectiveness against recovery time.
A Tension-Free Vaginal Tape procedure (TVT) should give a good cure for women, requiring an overnight hospital stay and only a short time off work. Whilst no operation can guarantee a 100% permanent cure, this will give a good result in over 90% of cases.
Operations, however, do not usually cure problems such as going to the toilet frequently, getting up at night, or urgency and associated leakage. If these issues are also present, surgery alone will not help and medication may need to be taken separately to address these after the operation.
The procedure
A TVT is usually carried out when the patient is awake. She will not see the procedure or be in any pain. This effect can be achieved with either a combination of local anaesthetic and sedative, or under a spinal anaesthetic - similar to an epidural and is the main anaesthetic used for caesarean sections.
Two 1/4 inch incisions are made in the skin of the abdomen, just above the bone at the top of the pelvis.
Another small incision is made just inside the vagina. A special instrument is then used to pass a tape up until is appears out of the small abdominal incisions. The tape is made of a special form of nylon called prolene and acts rather like 'velcro'.
The tape is placed under the urethra and then the patient will be asked to cough. This is why the patient needs to be awake during the operation.
There is no need for the patient to worry or to be embarrassed if leakage occurs - this is exactly what is required! The tape is then gently pulled up until the leakage stops, ensuring that the tension is just right for the individual and thus resulting in a quicker recovery.
No stitches are needed to hold the tape in place as it grips the surrounding tissues. However, two small stitches will be required in the abdomen and a few in the vagina, which will dissolve.
The whole operation takes 30-40 minutes. It may sometimes be necessary to leave a catheter in until the anaesthetic wears off, but this is not always required. It should be possible for the patient to pass urine (and not leak) almost immediately and go home the following day.
After-care When the patient is home it is advisable to avoid heavy lifting or straining for about two weeks. It should be possible to return to work after two to four weeks depending on the nature of the job. Sexual intercourse should be avoided for around four to six weeks to allow the vagina to heal properly - this should be completely back to normal well before six weeks. During the time the stitches are dissolving, there may be some discharge or even small pieces of suture coming away. This is normal so there is no need to worry. Another appointment will be made at around six weeks and if all is well the patient will be discharged. |
20/05/2009