Surgical treatment of urinary incontinence
It is estimated that one out of five women suffers from urinary incontinence (involuntary leakage of urine). The incidence of urinary incontinence rises with age. If urine leaks as a result of physical strain or exertion, for example when coughing or sneezing, this condition is called stress incontinence. In this type of incontinence the amount of leakage at a time is usually small. Mild stress incontinence is treated with pelvic floor muscle exercises and lifestyle changes, including losing weight. If pelvic floor muscle exercises and other treatments do not help, female stress incontinence can be treated with surgery in which a sling of mesh tape, made of tissue-friendly synthetic material, is placed under the urethra to support the tissue around the urethra.
The type of urinary incontinence and the treatment for it is determined at an appointment with a gynaecologist. To assist the assessment, the patient should fill in the attached questionnaires and bladder diary before the appointment. At the appointment, a cough stress test is performed, and therefore the patient’s bladder should contain about 300 ml of urine.
BEFORE THE SURGERY
The skin and mucous membrane in the operation area must be healthy. The patient must not have urinary tract or vaginal infection at the time of the surgery. If she uses local oestrogen therapy, it is important to continue it until the surgery. Even though the surgery is usually performed under local anaesthesia, the patient must not eat or drink for six hours before the surgery.
The surgery for urinary incontinence takes about 30 minutes. It is usually performed under local anaesthesia. Analgesic (painkiller), if necessary, will be administered intravenously. During the procedure, a mesh tape is placed under the urethra using special instruments. The tape is inserted
- using a TVT procedure, i.e. through small incisions made in the skin above the pubic bone and in the vagina, or
- using a TOT procedure, i.e. through small incisions made in the skin in the groin and in the vagina
The correct tension of the mesh tape is adjusted during the surgery. The bladder is filled through a catheter and during a cough stress test the tension is adjusted to provide enough support to prevent leakage.
After the surgery, the patient’s ability to urinate will be monitored. She should try to pass urine three hours after the surgery at the latest, even if she does not feel the need. After passing urine, the bladder is checked for how well it has emptied. The patient will be discharged as soon as the bladder empties well enough.
AFTER THE SURGERY
The effect of intravenous medication may last for up to 24 hours, during which the patient may feel tired and weak. Driving a car and other activities that require a high level of concentration are prohibited for 24 hours after the procedure. After the procedure, the patient will need someone to take her home from the hospital as well as a support person to assist her at home until the following morning.
There will be pain in the operated area after the surgery, for which the doctor will have prescribed painkillers. At the beginning, it is worth taking the painkillers regularly as they also reduce swelling in the wound area. The patient may have bleeding or bloody discharge from the vagina for a week, and may feel discomfort for even longer in the operated area and around the wound as well as when she urinates. Washing the genital area several times a day is important, and it will also speed up the recovery of the wound in the vagina. There are no restrictions regarding sauna bathing after the surgery. There will be no stitches that need to be removed.
The patient will need sick leave for 7–10 days and must avoid heavy work and physical exertion during the sick leave. Gentle exercise will stimulate circulation in the operated area and speed up recovery. The patient must avoid swimming, the use of tampons and sexual intercourse during the sick leave.
COMPLICATIONS RELATED TO THE SURGERY AND RECOVERY
The recovery from the surgery usually goes well. Most postoperative problems are minor and do not essentially extend the period of treatment or slow down the recovery.
The most common complication related to the surgery is urinary tract infection, which may require a course of medication. Infections and haematomas in the operated area may also occur. It is usually possible to urinate normally already on the day of the surgery. Sometimes it is necessary to continue emptying the bladder through a thin plastic tube at home (self-catheterisation) until the bladder begins to empty properly. The patient will be taught how to do this before she is discharged. Even in this case she will be discharged on the day of the surgery.
Sometimes other rare complications that are not mentioned here may occur. Being overweight or having had earlier surgeries may increase the risk of complications. Poor general condition or some other disease may also increase the risk. Smoking slows down the recovery of the wounds and generally increases the risks associated with the surgery.
Urinary incontinence can recur over the years. To prevent this, it is advisable to start exercising the pelvic floor muscles after the sick leave.