Pubovaginal Sling
Indication
Treatment of stress urinary incontinence, recurrent incontinence.
Surgical Technique
Many different types of slings exist.
A combination of abdominal and vaginal surgery is performed. The abdominal surgeon performs the surgery through a lower abdominal incision. Strong tissue from the deep abdominal wall (rectus sheath) is fashioned into a sling and with the aid of the vaginal surgeon is placed under the bladder neck (upper urethra). The sling material is secured to the rectus sheath of the anterior abdominal wall. The vaginal and abdominal incisions are closed. A diagram of the surgery is shown below.
Surgery will be covered with antibiotics to decrease the risk of infection and blood-thinning agents will be used to decrease the risk of clots forming in the postoperative phase.
Serious complications are rare with this type of surgery. However, no surgery is without risk and the main potential complications are listed below.
- 10-15 % failure rate
- 5-10% voiding difficulties that will require catheter use at home
- 10-15% bladder urgency or urge incontinence
- Wound or urinary tract infection in 5%
- Blood loss requiring transfusion <1%
- Clotting in the legs or lungs in 1%.
- Damage to the bladder or lower urinary tract <1%
In Hospital
You can expect a 4-6 day hospitalisation. After the operation you will have an I.V. drip in your arm for several days and a small catheter will drain your bladder for 2-3 days. In the early postoperative period the nurses will check that you are emptying your bladder appropriately.
During Recovery
In the early postoperative period you should avoid situations where excessive pressure is placed on the repair ie lifting, straining, coughing and constipation. Maximal fibrosis around the repair occurs at 3 months and care needs to be taken during this time. If you develop urinary burning, frequency or urgency you may have a bladder infection and your local medical officer should be contacted. You will see Dr Maher at 6 weeks and sexual activity can usually be safely resumed at this time. You can return to work at approximately 3-6 weeks, depending on the amount of strain that will be placed on the repair at your work and on how you feel.
Avoiding heavy lifting, weight gain and smoking can minimize failure of the procedure in the long-term. If you have any questions about this information, you should speak to Dr. Maher before your operation.