Patient education: Surgery for stress urinary incontinence in females (The Basics)

What is surgery for stress urinary incontinence? — 

Stress urinary incontinence is a condition where a person leaks urine when they laugh, cough, sneeze, or do anything that puts pressure on the belly.

Doctors can do surgery called "urethral suspension" to treat this condition in females.

Urethral suspension is usually done as a "minimally invasive" surgery. This means the doctor makes small cuts ("incisions") in the skin of the abdomen. They insert long, thin tools through the incisions to do the surgery. If you get minimally invasive surgery, you can usually go home the same day.

Sometimes, doctors have to do "open" surgery instead. This means they make a larger incision in the abdomen and work directly inside the body.

What are the different types of surgery to treat stress urinary incontinence? — 

There are 2 main types:

●"Sling procedure" – A sling is a small piece of material that goes around the urethra (figure 1). (The urethra is the tube that carries urine out of the body.) There are different types of slings, but they all give the urethra support to help keep it from leaking urine. The sling can be made of artificial mesh or tissue from your own body.

For both types, the doctor will make a small incision in your vagina to put the sling in. Depending on the type of sling, they might also make small incisions on your lower belly or inner thighs.

●"Burch procedure," also called "retropubic colposuspension" – This is less common. The doctor attaches the tissue around the urethra to strong bands of tissue inside the pelvis. This helps keep the urethra from leaking urine. This procedure can be done with minimally invasive or open surgery.

Before surgery, the doctor will talk with you about what kind of surgery you will have and what to expect.

How do I prepare for urethral suspension? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before the procedure, your doctor will do an exam, including a pelvic exam. You might also need:

●Blood or urine tests

●Ultrasound or other imaging tests – These create pictures of the inside of the body.

Your doctor will also ask about your "health history." This involves asking about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes prescription or "over-the-counter" medicines, plus any herbal supplements. It helps to write down and bring a list of your medicines, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before the procedure – You might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.

●Lowering the risk of infection – You might need to wash the area with a special soap.

●What help you will need when you go home – For example, you will need someone else to bring you home. You might want someone to stay with you or help you with meals while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during urethral suspension? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines to make sure you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This blocks pain in 1 area of your body, such the lower half of your body. You might be awake. Or you might get "sedative" medicines to help make you relax and feel sleepy.

•General – This makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●Urethral suspension surgery can be done in a few ways. Based on the type of surgery you are having, the doctor might:

•Make small incisions in your vagina, belly, or thighs

•Use mesh or tissue from your own body to make a sling to suspend your urethra or bladder

•Use stitches to support the tissue around your bladder, urethra, or vagina

●The doctor will close your incisions and cover them with clean bandages.

●Sling procedures usually take about 30 minutes. Burch procedures usually take about an hour. If you are having other procedures done at the same time, it will take longer.

What happens after urethral suspension? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. You might be able to go home the same day. Or you might need to stay in the hospital for a day or so.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will check your bladder function in the recovery room. If you cannot empty your bladder on your own, you might get a urinary catheter to use at home.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine to help with pain, if needed. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of urethral suspension? — 

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●Bleeding or blood clots

●Infection

●Bladder spasm (when the bladder muscle tightens without warning), trouble urinating, or needing to urinate suddenly or in a hurry

●Injury to the bladder, urethra, or other nearby organs

●Trouble urinating, or not being able to urinate all (if you had a sling procedure) – This usually goes away in a week or so, but in the meantime, you might need to use a urinary catheter.

●Still having urine leakage

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Deciding about surgery for stress urinary incontinence in females (The Basics)
Patient education: Urinary incontinence in females (The Basics)
Patient education: Minimally invasive surgery (The Basics)
Patient education: How to care for a urinary catheter (The Basics)
Patient education: How to use a catheter to empty the bladder in females (The Basics)
Patient education: Bladder spasm (The Basics)

Patient education: Urinary incontinence treatments for women (Beyond the Basics)
Patient education: Urinary incontinence in women (Beyond the Basics)