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

How is it done?

• 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.

What to expect after the procedure?

• 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.

Wes Sling Rectus Fascial CADAVERIC

• Main incontinence surgery for ladies in the previous millennium. Making a resurgence in the post mesh-era.
• Open retropubic vs robotic assisted procedure.
• Lower success rates as the Sling procedure, and more invasive.

Indication:

• Confirmed SUI
• Hypermobile urethra

Procedure:

• Robotic assisted procedure
• Done under a GA
• Sterile filed with BETADINE
• 4 Robotic ports and 2 assistant ports placed
• Abdomen insufflated with CO2
• Head in Trendelenburg
• Prophylactic antibiotics
• An IDC placed
• The retropubic space opened and the para-urethra vaginal wall is lifted and fixed to the pectineal line with 3 sutures on each side
• Tension on these sutures to create a kink in the urethra
• Vagina is inspected to exclude any sutures placed through the wall.
• Abdomen is inspected for any bowel injuries
• Drain is placed

Complications:

• Wound infection
• Ileus
• Acute urine retention
• May require self-catheterization
• Return to theatre to release the tension

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Wes Burch Para-Urethral Repair – Open

The aim is to alter the neuro-transmission from the Spinal Centre to the Bladder

Why is it done?

• Confirmed OAB where a trial not required
• Detrusor Sphincter Dyssynergia, DSD
• Incomplete bladder emptying, large post-void residual urine volumes
• Underactive bladders
• Chronic pelvic pain
• Causative factors:
  • Undetermined
  • Neurogenic causes such as Multiple Sclerosis,
  • Diabetes

How is it done?

• Sedation is administered with a local anesthetic of the wound sites
• You will be placed prone (on your stomach) with lower back and buttocks exposed
• Area prepared with Betadine, unless allergic
• The tined lead will be placed in the S3 foramina of the sacrum under imaging
• The lead will be tunneled under the skin and connected to an Internal Battery
• A pocket will be made for the permanent subcutaneous battery and connection
• Subcutaneous sutures will be placed, which will dissolve.

Complications

• Some local discomfort may be experienced.
• A nerve stimulator may provide abnormal sensations, which your body adjusts to.
• A Representative from Medtronic will be in contact with you to check on your settings and responses.
• A review at my rooms with Medtronics will be scheduled at 6 months, to confirm that the device is functioning optimally
• Further review appointments will be scheduled as required
• The battery should last between 15 years
• NB! Each person is unique and for this reason, symptoms may vary!

Download Information Sheet

Wes Sacro Neuro Modulation Full Implant

Copyright 2019 Dr Jo Schoeman

Why is it done?

• Where Intrinsic Sphincter Deficiency has been proved after failed previous sling.

How is it done?

• This procedure is done under a spinal / general anesthetic, as decided by the anesthetist.
• The legs will be elevated into the lithotomy position.
• This procedure is done cystoscopically.
• 3 peri-urethral injections are made with injection of Macroplastique/ Bulkamid until the urethral lumen closes.
• Your urine output will be measured each time you 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.

What to expect after the procedure?

• Any anesthetic has its risks, and the anesthetist will explain all such risks.
• Complications of hemorrhaging and urine retention.
• Patients will have no catheter when they wake up.
• If you cannot urinate after 2-3 attempts, an in-out catheter may be inserted to empty your bladder.
• You may be required to self-catheterize for a week or two.
• NB! Each person is unique and for this reason symptoms may vary!

What next?

• Patients will have a trial of void without catheter after the procedure
• 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 (rarely necessary).
• Patients may initially suffer from urge incontinence, but this will improve within the next 6 weeks.
• Allow 6 weeks for symptoms to stabilize.
• You may not experience a full return of continence, and the effects may worsen with time.
• More than 1-2 treatments may provide the desired effects.
• 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.

Download Information Sheet

Wes Peri-Urethral Bulking