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Feminine Incontinence Treatments in Montreal

What is Urinary Incontinence?

Urinary incontinence is defined as any involuntary leakage of urine that causes discomfort. There are several types of urinary incontinence:

  • Stress incontinence: leakage occurs during exercise (sports, coughing, laughing, sneezing, walking, change of position, etc.).
  • Urge incontinence: this occurs when there is an urgent need to go to the bathroom, and you are unable to wait.
  • Mixed incontinence: this is a combination of both stress and urge incontinence.


What Causes Stress Incontinence?

This is the result of:

  • A weakening of the pelvic-floor muscles (pelvic floor: the part of the body that closes the pelvis and which is crossed by the lower part of the urinary, genital and digestive tracts) which are responsible for supporting the bladder and urethra.
  • It is often the result of pregnancy and childbirth as well as tobacco, menopause and excess weight.
  • A weak urethral sphincter (the muscle responsible for the tightness of the bladder).


What Causes Urge Incontinence?

There are often many factors.It occurs without any sign of injury or neurological explanations.


How Can Urge Incontinence Be Treated?

  • Diet
  • Behavioural
  • Perineal rehabilitation
  • Medical treatment
  • Intra-vesical botox injection treatment
  • Surgical treatment
  • Neuromodulator implants


How Can Stress Incontinence Be Treated?

  • Perineal rehabilitation
  • Sling surgery
  • Intra-urethral collagen injection
  • Vaginal laser treatment

Why Sling Surgery?

If pelvic floor rehabilitation has failed or if the stress incontinence is serious, surgery is usually one of the most efficient means of permanently preventing the leaks. There is currently no available medication for stress incontinence.


The Surgical Procedure

During the surgery, the surgeon places a small strip of synthetic mesh under the urethra. This hammock-like strip remains under the urethra, providing support during exercise and thereby preventing leakage. The mesh is placed and positioned under the urethra using needles.


Various types of mesh with different methods of installation are available. Your surgeon will choose the one best suited for you according to your case and experience.


As with any surgery, a pre-operative evaluation is required if you are over 40 years old and need spinal or general anesthesia.


Antibiotic prophylaxis is also required on the morning of surgery. A Cipro tablet is usually given with a little water.


Surgical Technique

There are several surgical techniques used to treat feminine incontinence. Dr Marois uses two techniques, which are adapted to his patients’ needs.


Sling Surgery

The procedure is usually performed in a hospital under general or spinal anesthesia. However it is now available in clinics or in private operating rooms depending on the technique used. The procedure usually lasts 15-30 minutes.


The patient is placed in the exaggerated lithotomy position with the heels placed in high flexible stirrups in order to maximize the explosion. The surgical area is then disinfected using proviodine. A sterile surgical drape is then placed.


A urinary catheter is installed temporarily for the duration of the surgical intervention. A short incision of 2 to 3 cm from the vaginal mucosa is made under the urethra. A dissection is conducted under the vaginal wall and on each side of the urethra straight to the lower pubic branch. A space is then created through digital palpation in order to positioning of the tape. There may be slight bleeding. The wound is the closed using absorbable wire.


Single Incision Urethropexy

The procedure is carried out under local anesthesia and sometimes with sedation. It can be performed at the hospital or in a minor operating room at the office. This technique is mainly designed for slim and physically active young women.


The polypropylene tape is small (3 cm long by 1 cm wide). It is anchored to the internal face of the obturating holes with small titanium anchors with a tunneler. The bladder is filled with around 300 cc of sterile water. The tape is then progressively adjusted in order to correct the incontinence caused by the patient’s spontaneous coughing. Sedation generally dissipates rather quickly. Most patients can return home approximately 2 hours after the procedure.


The benefits of this technique:

Single Incision Urethropexy
  • There is no general or spinal anesthesia
  • There is no cutaneous incision, therefore no bandage
  • There is no passing of the tape beyond the obturating membrane; therefore there is no risk to the adductor muscles of the thighThere is little post-operative pain
  • You can resume normal activities more quickly (possibility of resuming most normal activities the very next day).
  • No physical or sexual activity for 2 weeks
  • Results are the same or very close to those obtained with TOT

Urethropexy with Trans-Obturator Tape (TOT)

This intervention for stress urinary incontinence is performed under general or spinal anesthetic in a hospital or in a private operating room. It can be performed under local anesthesia in a private clinic. Dr. Marois makes a small vaginal incision and places the tape, the two branches of which are picked up by a tunneler via 2 incisions made above the pubis and left just under the skin.


The tape is therefore simply placed there, with no tension. Progressively, it will be colonized by tissue to which it will adhere. When pressure occurs, the tape provides a base for the urethra to rest on and keeps it from descending. Small bandages are placed on either side of the superior region of the vulva.


This surgery has many advantages:

  • The surgery is quick and not very invasive
  • The tape stays in place due to tissue colonization
  • There are no sutures nor open retropubic intervention
  • The vaginal incision measure one to two centimetres
  • There is little risk of infection or of scarring problems
  • It is performed in day surgery
  • The convalescence period is 4 weeks
  • It is indicated for elderly or heavier people due to all the above advantages


Postoperative

The urinary catheter is removed at the end of surgery. A panty liner is then left in place ... The surgical procedure is painless.


You may feel a burning sensation during urination or you may find that the flow of urine is very weak. Vaginal discharge may occur for a few days.


The average recovery time is about two weeks. This period may be adjusted to suit your profession. The day after the surgery, you can resume normal activity but you should avoid any activity that includes excessive efforts and or lifting heavy loads (greater than 5 kg or 20 lbs.). You can resume sexual relations and sports after four weeks. Once the wound has healed, your sexuality should not be affected.


You must avoid baths and swimming for a week. A shower can be taken after 24 hours.


If you experience persistent urinary burns, urine problems or "strong" odour, fever, significant difficulties urinating, be sure to consult your doctor.


Risks and Complications

Practised since 1995, this technique has become the benchmark procedure for feminine stress incontinence. In most cases, there are not any postoperative complications. However, each surgery involves a number of risks and complications as described below:


The early and late risks and complications are generally minor:

  • Urethral trauma (0-1%)
  • Preoperative hemorrhage over 300 ml (3%)
  • Vascular incidents (very rare)
  • Pain in the pelvis or legs 24 to 48 hours post-operation
  • Urinary infection (4-22%)
  • Defective vaginal scarring or erosion
  • Local hematoma (1-2%)
  • Late pain (from granuloma on the tape or periosteal inflammation)
  • Urinary retention (1-27%)
  • Frequent urination, urgency (13-15%)
  • Post-operative dysuria, or weaker stream (30%)


If any complication or problem occurs outside our business hours, or if you are not able to join a secretary to make an appointment, please report to Verdun Hospital Emergency. The emergency physician will try to join Dr. Marois to get his report. Dr. Marois will then be able to give his recommendations over the telephone or will come to see you directly at the emergency room.

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