Cadaveric Fascial Sling – Fascia Lata

Why is it done?

Stress incontinence
A combination of stress incontinence and detrusor over-activity of which DO the lesser
Involuntary urine leakage with any exertion, coughing or sneezing
Risk factors
- More than 2 pregnancies, big babies, complicated deliveries, episiotomy
- Smokers
- Being overweigh
Where Intrinsic Sphincter Deficiency has been proved due to a failed previous sling
Failed previous incontinence procedures

This procedure is done under a spinal / general anaesthetic, as decided by the anaesthetist.
The legs will be elevated into the lithotomy position.
A cadaveric fascia-lata will be used
A small incision is made in the vagina.
The sling is placed behind the pubic bone and brought to the skin above the pubic bone, through the incision.
The sling is placed with some tension.
The bladder will be inspected with a Cystoscopy to exclude any injuries to the bladder wall.
The wounds are closed with dissolvable sutures and/or skin glue.
A local anaesthetic is given for pain relief.
A urinary catheter is placed for 24hrs.
A vaginal plug will also be placed.
The catheter and plug will be removed early the next morning.
The patient’s urine output will be measured each time they urinate, and the residual will be measured. (Patients will be required to do this up to 3 times.)
If the residual amount of urine is more than 1/3 of the total bladder capacity, the patient may have to self-catheterize, until the residual volume is acceptable.
Prophylactic antibiotics will be given to prevent infection.

Any anaesthetic has its risks, and the anaesthetist will explain all such risks.
Complications:
- hemorrhaging, requiring blood transfusion <1%;
- bladder perforation, requiring an open repair <1%.
Patients will wake up with a catheter in the urethra and bladder. This will remain in the bladder for at least 24 hrs.
Wound discomfort/pain will persist for a few days but this will subside / settle.
You may be required to self catheterize for a week or two.
If there is no improvement the sling may be cut, to allow spontaneous urination
NB! Each person is unique and for this reason symptoms may vary!

What next?

Patients will have a trial of void without catheter the next day.
Patients will be discharged as soon as they can completely empty the bladder.
Patients may be required to self catheterize for a week or two.
Patients may initially suffer from urge incontinence but this will improve within the next 6 weeks.
Allow 6 weeks for symptoms to stabilise.
May also have abdominal pain with coughing and sneezing due to tension on rectus muscle
There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
On discharge a prescription may be issued for patients to collect.
Patients are to schedule a follow-up appointment in 6 weeks.
Please direct all queries to Dr Schoeman’s rooms.
PLEASE CONTACT THE HOPSITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.