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.
There are several surgical techniques used to treat feminine incontinence. Dr Marois uses two techniques, which are adapted to his patients’ needs.
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.
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:
Urethropexy with Trans-Obturator Tape (TOT) in a Private Operating Room
This intervention for stress urinary incontinence is performed under general anesthesia in a private hospital. It does not require hospitalization. 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 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.
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:
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.
Before Undergoing Urethropexy
An evaluation appointment is required at one of our two offices. Cystoscopy and vaginal examination are performed to evaluate incontinence. Surgery is then discussed.
If the surgery is performed in a private clinic, we will propose a date to you. If the surgery is performed in a private operating room, it is then planned in the Centre Métropolitain de Chirurgie, the only private hospital accredited in Quebec.
A blood work, an ECG and a preoperative meeting with a nurse are also necessary. She will be able to answer any additional questions you may have about the surgery.
Lastly, we need to obtain the approval of a CMC anesthesiologist to ensure your health allows general anesthesia.
Call us for more information about our private practice and hospital services.