Strip under ureteral TOT

Urinary incontinence is defined as any involuntary leakage of urine.

There are several types of urinary incontinence:

  • Stress urinary incontinence
  • Urinary incontinence by urgency: it translates urgent needs that it is not possible to retain.

  • Mixed urinary incontinence: it combines leaks to the effort and urgency-leak.

What is due the stress urinary incontinence?

It is the result:

  • Weakness of the muscles of the perineum (perineal: part of the body closing down the small pelvis and crossed by the termination of the urinary, genital and digestive tract) loaded to support the bladder and urethra.
  • A weakness of the sphincter of urethra (muscle responsible for ensuring the tightness of the bladder).

Women is readily prone to this disability because her urethra is very short, its less powerful sphincter, her perineum weakened by several holes for inserting the urethra, the vagina and the rectum. His perineum is subject to strain during pregnancy and especially of childbirth.

Finally, the lack of hormones after menopause leads to drying of tissues and a further fragility.

Why this intervention?

When the perineal rehabilitation has failed or the stress incontinence is very important, intervention is currently one of the most efficient ways to permanently remove leaks to the effort.

No drug is currently active on the female stress urinary incontinence.

Principle of intervention

It is to position under the urethra a small strip in synthetic material. This strip, such a hammock, will remain under the urethra, supporting in the effort to prevent leaks. Different strips with different laying systems are marketed. Your surgeon will pick the one that is best suited to your case and experience.

Note that all urinary exciting outside of this intervention. This technique will be chosen by your doctor after you have considered and applied where appropriate, some examinations as a urodynamic.

Figure 1. Diagram of the female pelvic Anatomy
Diagram of the female pelvic Anatomy

 

Figure 2. Implementation does not place of a suburethral Sling
Implementation does not place of a suburethral Sling

Intervention preparation

Before the intervention: as for any surgical intervention, an anesthesia consultation takes place a few days before the intervention. The choice of anesthesia: local anesthesia, anesthesia locoregional (only the lower part of the body is sleeping) or general anesthesia (asleep completely) is performed by the surgeon and the anesthesiologist depending on your folder and taking into account your opinion.

Surgical technique

The intervention takes place after ascertaining, by a recent analysis of urine, that you have no urinary tract infection. In the event of infection, your intervention is deferred until sterilization of urine.

In the operating room, in lithotomy position, three small incisions are made, a 1.5 cm inside the vagina, two of a few millimeters on the pubis or the root of the thighs. The Strip is passed and positioned under the urethra with needles.

At the end of intervention, can be put in place a catheter in the bladder and a buffer in the vagina. The intervention lasts 20 to 30 minutes.

Standard suites

The urinary catheter and vaginal buffer are removed after consultation with your surgeon, after a few hours. The duration of the hospitalization is usually a few hours to 48 hours. The procedure is not painful.

You can feel some burning when urinating or observe as you urinate with a smaller jet. Vaginal discharge are possible for a few days.

The duration of convalescence is on average two weeks, this duration that can be adapted according to your profession. Upon your release, you can resume normal activity by avoiding violent efforts and carrying heavy loads (greater than 5kg). You must avoid the bathroom and abstain you from sexual relations and sports for four weeks. A consultation of control is expected a few weeks after your surgery.

In the event of persistent urinary burning, cloudy urine or smell «high», fever, difficulty to urinate, feel to your doctor.

Risks and complications

Practiced since 1995, this technique became the intervention of stress urinary incontinence of women reference. In the majority of cases, the intervention that is proposed to you takes place without complication. However, all surgery involves a number of risks and complications described below:

  • Some complications are related to your general condition and anesthesia; they will be explained during the preoperative consultation with the anaesthetist doctor or surgeon and are possible in any surgical intervention.
  • Complications directly in relation to the intervention are rare, but possible:
    • During the intervention: the recent passage of the Strip techniques are very safe and the complications during the rare intervention (bladder wound, wound of the urethra, haemorrhages and haematomas)
    • Serious complications: any intervention, however small, has exceptional and unforeseeable risks but sometimes very serious (vascular wound, cardiac event, allergy…). It is recalled that any surgery involves a number of risks including vital, due to individual variations that are not always predictable. Some of these complications are exceptional occurrence (wounds of vessels, nerves) and may sometimes not be curable. During this procedure, the surgeon may find themselves in front of a discovery or requiring unforeseen event of acts additional to or different from those originally planned, or even an interruption of the planned Protocol.
    • After the intervention:
      • InfectionsLa urinary catheter may favor the occurrence of a urinary tract infection. In the case of urinary tract infection, a few days of antibiotics allow a rapid healing. The Strip is very well tolerated and integrated in the body, the risk of her infection is exceptional.
      • Difficulties in urinerIl is usual to urinate with a less powerful jet after the intervention. Sometimes, significant difficulties require to keep the urinary catheter a few extra days. When these difficulties persist, your surgeon will decide on the opportunity of a reintervention.
      • Cravings Frequentesil is sometimes discovered after the intervention of the desire to urinate more frequently and more urgent. These abnormalities usually disappear in a few days or weeks. In case of persistence, please talk to your surgeon.
      • Sexualitedes then that the vaginal incision has healed, the intervention does not change your sexuality. Exceptionally, it is possible that you or your partner feel the Strip into the vagina.
      • DouleursL'intervention requiring no large incisions or traumatic gestures, pains are usually minimal and limited to the few days after the intervention. It is sometimes possible to feel some pain and cramps in the root of the thighs.
      • CicatrisationLes problems at the level of the skin incisions heal in about ten days. At the level of the vagina, healing defects are sometimes found. Tell your surgeon an abnormal vaginal discharge.
      • Subsequently: regular monitoring is necessary. Feel free to consult your doctor once a year or in case of anomalies (frequent cravings, difficulty urinating, repeated urinary tract infections, abnormal vaginal discharge).

Warning

Smoking increases the risk of surgical complications from any surgery. Quit smoking 6-8 weeks before the intervention eliminates this extra risk.

If you smoke, talk to your doctor, your surgeon and your anesthesiologist or call the Tabac‑Info‑Service line at the 3989 to help you reduce the risk and put all the chances on your side.

Results

The result on incontinence is usually very good (85-90%), but cannot be guaranteed. However, relapses of urinary stress incontinence may still occur and be corrected.