Stress Urinary Incontinence:

Everything You Need to Know About Surgery for Urinary Leaks

Dr. Claude Allouche, Gynecologist IUE engl

Ahuza Clinic, Raanana
Phone: 058 726 02 64

Stress urinary incontinence, which causes significant discomfort, can be treated with surgery. This guide provides information about the principles, benefits, and risks of this procedure recommended by your doctor.

1. Surgical Treatment for Stress Urinary Incontinence (SUI)

Goal: Reduce or stop urinary leaks caused by physical exertion.
Procedure: A synthetic sling is placed under the urethra to support it during activities, preventing its opening and therefore stopping urine leaks.

This surgery is typically performed after pelvic floor rehabilitation has failed.

2. Procedure Details

  • Anesthesia: General or regional anesthesia.
  • Duration: 20 to 30 minutes.
  • Techniques: The choice of technique depends on the physician, but the main difference lies in how the sling is secured.

Retro-pubic Approach (TVT = Tension-free Vaginal Tape)

  • A synthetic sling is placed under the urethra through the retro-pubic route (behind the pubis).
  • A small incision is made in the front wall of the vagina just below the urethra, and two small incisions are made above the pubis to pass the sling.
  • The sling is placed without tension under the urethral canal.

Obturator Approach (TOT = Trans-obturator Tape)

  • Similar to TVT, but the incisions are made in the crease between the thigh and vulva, not above the pubis.

  • The sling is placed laterally to form a "hammock" under the urethra.

  • Verification: Cystoscopy is performed to check for bladder injury.

  • Accessories: A urinary catheter and vaginal tamponade are used at the end of the procedure.

3. Post-Operative Care

  • Hospital Stay: 24 to 48 hours. If the stay exceeds 24 hours, an anticoagulant is prescribed.
  • Catheter and tamponade: Removed a few hours after surgery.
  • Urination: Urination is carefully monitored to ensure proper bladder emptying.
  • Diet: You can resume eating the same day.
  • Pain Management: Painkillers are administered according to a prescribed protocol.
  • Work Leave: A work leave certificate will be provided before discharge.

4. Potential Risks and Complications

Although the technique is well-established, there are some risks associated with anesthesia and the surgery itself.

During the Surgery

  • Bladder injury
  • Urethral injury (rare)
  • Hemorrhage or hematoma

Post-Operative Risks

  • Post-operative pain
  • Urinary tract infection
  • Difficulty urinating
  • Issues with wound healing
  • Frequent or urgent need to urinate
  • Pain during intercourse (very rare)

5. Post-Operative Recommendations

It is generally advised to follow these recommendations for about 4 to 6 weeks after surgery:

  • Drink 1.5 liters of water daily.
  • Take showers (baths and swimming pools are not allowed).
  • Avoid heavy lifting and limit physical activity.
  • Abstain from sexual activity for 1 month to allow vaginal healing.
  • Avoid medications containing aspirin for one week.
  • A follow-up appointment will be scheduled a few weeks after surgery.

6. Alert Symptoms to Report to Your Doctor

Contact your doctor immediately if you experience:

  • Fever above 38°C (100.4°F)
  • Persistent urinary burning
  • Inability to urinate
  • Severe pain
  • Abnormal bleeding
  • Vomiting
  • Any other concerning symptoms

7. Surgical Outcome

The results of the surgery for urinary incontinence are generally very positive, but there are no guarantees. Recurrence of stress urinary incontinence requiring further treatment can happen.

Sources:

  • Urofrance.org
  • Santevitalite.be