Retropubic Sling Incontinence Procedure

Why is it done?

• Stress incontinence.
• A combination of stress incontinence and depressor overactivity.
• Involuntary urine leakage with any exertion, coughing or sneezing.
• Risk factors:
  • More than 2 pregnancies, big babies.
  • Complicated deliveries, episiotomy.
  • Smokers.
  • Being overweight.
• Where Intrinsic Sphincter Deficiency has been proved due to a failed previous sling.

Pre-requirements

• An informed consent is required from the patient and a pre-admission clinic will be arranged.
• Patients may not eat or drink from midnight the previous evening.
• Patients are to refrain from smoking before the procedure.
• Patients allergic to IODINE / CHLORHEXIDINE should clearly state this at the pre-admission clinic as well as to theatre staff and Dr Schoeman.
• Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. This may be replaced by once daily Clexane injections.
• Pre-operative blood tests are required 4 days prior to surgery.
• Patients with cardiac illnesses require a cardiologist/ physician report.
• A chest X-ray is required for patients with lung disease.
• Be prepared for an overnight stay.

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 small incision is made in the vagina. The sling is placed behind the pubic bone and brought to the skin above the pubic bone, with a small incision.
• The sling is placed tension free.
• If you have a suspected Intrinsic Sphyncter Deficiency (ISD), the sling may be placed tighter.
• 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 catheterise, 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 24 hrs.
• Pubic bone area discomfort/pain will persist for a few days but this will subside / settle.
• If you cannot urinate after 2-3 attempts, the sling may be readjusted.
• 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.
• 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

Sling Retropubic