Background Information:

What are the other Names for the Procedure?

• Retropubic Suspension
• Tension Free Vaginal Tape
• Vaginal Sling Procedures

What is Stress Incontinence Operations surgical procedures?

• Stress Incontinence Operations are procedures that involve alleviating the condition of individuals who are experiencing uncontrollable leakage of urine from the bladder
• They may be performed using any of the following methods:
  • Retropubic Suspension
  • Tension Free Vaginal Tape
  • Vaginal Sling Procedures

What part of the Body does the Procedure involve?

Stress Incontinence Operations involve the urethra.

Why is the Stress Incontinence Operations surgical procedures Performed?

Stress Incontinence Operations are performed for the following reasons:

• To improve a woman’s quality of life, who is experiencing a complete loss of bowel or bladder function
• Repairing abnormal bladder deficiencies

What are some Alternative Choices for the Procedure?

Special material may be injected into the urethra (injectable implants) whenever the incontinence is due to a weak urinary sphincter muscle (the muscle that helps control urination).

What are the Recent Advances in the Procedure?

Minimally-invasive techniques used in laparoscopic Retropubic Suspension procedures have undergone further advancement and refinement.

What is the Cost of performing the Stress Incontinence Operations surgical procedures?

The cost of Stress Incontinence Operation procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Stress Incontinence Operations and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

http://www.nlm.nih.gov/medlineplus/ency/article/007377.htm (accessed on 05/14/2015)

http://www.nlm.nih.gov/medlineplus/ency/article/007376.htm (accessed on 05/14/2015)

http://www.nlm.nih.gov/medlineplus/ency/article/007374.htm (accessed on 05/14/2015)

http://www.nlm.nih.gov/medlineplus/ency/article/007373.htm (accessed on 05/14/2015)

Prior to Stress Incontinence Operations surgical procedures:

How is the Stress Incontinence Operations surgical procedures Performed?

The Stress Incontinence Operations may be performed under general or spinal anesthesia, using any of the following procedures.

Retropubic Suspension:

• It may be performed by making a larger incision on the lower abdomen (open procedure) or by making multiple small incisions on the belly to introduce a laparoscope and surgical instruments (laparoscopic procedure)
• The lowermost part of the bladder, adjoining part of the vagina and part of the urethra, are then tied to the pelvic bone and ligaments (tissue that connects bones) to give them support

Tension Free Vaginal Tape:

• The surgeon makes an incision inside the vagina and two incisions on the abdomen above the pubic hair
• A tape is then introduced through the cut made in the vagina and placed under the urethra (the tube that carries urine from the bladder to the outside)
• The two free ends of the tape are brought out through the incisions made on the abdomen and the tension on the tape is corrected
• Excess length of the tape that protrudes beyond the incision is then cut and the incisions are sutured

Vaginal Sling Procedures:

• The surgeon makes an incision inside the vagina and one on the abdomen above the pubic hair
• A sling made of biological tissue or a synthetic material is introduced through the vaginal incision and positioned from under the urethra. The other end is tied to tissues in the lower abdomen

Where is the Procedure Performed?

Surgery for Stress Incontinence is performed in a hospital.

Who Performs the Procedure?

An urologist or a gynecologist performs Stress Incontinence Operations.

How long will the Procedure take?

The procedures may take up to two hours to perform.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Stress Incontinence Operation procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for Stress Incontinence Operation procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Stress Incontinence Operations surgical procedures?

Before a Stress Incontinence Operation procedure, the patient has to undergo certain tests such as:

• Routine blood tests
• Cystogram

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What are Stress Incontinence Operations?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Stress Incontinence Operations surgical procedures:

What kind of Anesthesia is given, during the Procedure?

General anesthesia or spinal anesthesia is administered prior to the procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss during the Stress Incontinence Operations.

What are the possible Risks and Complications during the Stress Incontinence Operations surgical procedures?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Stress Incontinence Operations are:

• Excessive bleeding
• Infection
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Stress Incontinence Operations surgical procedures?

• After Stress Incontinence Operations, the patients are sent to an area of the hospital called the postoperative recovery area (or PACU)
• The patient’s blood pressure, heart rate, and respiration cycle shall be closely monitored. Any additional pain associated with the procedure will be treated
• Individuals are usually discharged from the hospital about 2-5 days after the surgery is performed

After the Stress Incontinence Operations surgical procedures:

What are the possible Risks and Complications after the Stress Incontinence Operations surgical procedures?

The possible risks and complications that may arise after Stress Incontinence Operations are:

• Excessive bleeding
• Signs of an infection
• Inability to urinate (urinary retention)

What is the Prognosis after the Surgery?

The prognosis after the stress incontinence surgical procedure is generally good.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Pain that worsens and swelling around the surgical wound
• Bleeding or fluid drainage from the surgical wound
• The occurrence of any symptom that causes uneasiness such as nausea, vomiting, prolonged constipation, or urinary retention
• Frequently having to urinate
• A burning sensation while urinating
• Fever, feeling sick
• Dizziness
• Headaches, muscle aches
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Stress Incontinence Operations surgical procedure?

At home, the following post-operative care is recommended after a Stress Incontinence Operation:

• Slowly resume regular/daily activities as early as possible, which aids in faster recovery
• Use a heat pad or warm compress to relieve pain due to the incision
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with mild unscented soap
• Replace dressing after showering
• Complete the course of prescribed medication, as advised by your physician
• Individuals may take acetaminophen to relieve pain. However, ask your physician if ibuprofen or aspirin is acceptable
• Avoid sex until complete healing has taken place (under advise by the physician)

How long does it normally take to fully recover, from the Procedure?

Complete recovery from Stress Incontinence Operations may take a few days to weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Stress Incontinence Operations surgical procedures?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• An anesthesiologist (if anesthesia was administered)
• A urologist or a gynecologist

The patient is advised to inquire and confirm the type of billing, before the Stress Incontinence Operations are is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA