Procedures
Feminine Incontinence Laser Treatments
Why Sling Surgery?
If pelvic floor rehabilitation has failed or if the stress incontinence is serious, surgery is usually one of the most efficient means of permanently preventing the leaks.
There is currently no available medication for stress incontinence.
Surgical Technique
There are several surgical techniques used to treat feminine incontinence. Dr Marois uses two techniques, which are adapted to his patients’ needs.
Différentes bandelettes avec différents systèmes de pose sont commercialisées. Votre chirurgien choisira celle qui est la mieux adaptée à votre cas et à son expérience.
Il existe plusieurs techniques de chirurgie d’incontinence féminine. Dr Marois utilise deux techniques adaptées aux besoins des patientes.
- Single Incision Urethropexy
- Urethropexy with Trans-Obturator Tape (TOT)
The procedure is usually performed in a hospital under general or spinal anesthesia. However it is now available in clinics or in private operating rooms depending on the technique used. The procedure usually lasts 15-30 minutes.
The patient is placed in the exaggerated lithotomy position with the heels placed in high flexible stirrups in order to maximize the explosion. The surgical area is then disinfected using proviodine. A sterile surgical drape is then placed.
A urinary catheter is installed temporarily for the duration of the surgical intervention. A short incision of 2 to 3 cm from the vaginal mucosa is made under the urethra. A dissection is conducted under the vaginal wall and on each side of the urethra straight to the lower pubic branch. A space is then created through digital palpation in order to positioning of the tape. There may be slight bleeding. The wound is the closed using absorbable wire.
La chirurgie peut être est réalisée en cabinet privé ou en en salle d'opération privée, elle est alors prévue dans le seul hôpital privé accrédité au Québec, soit au Centre Métropolitain de Chirurgie.
What are the necessary step for urethropexy?
An evaluation appointment is required at one of our two offices. Cystoscopy and vaginal examination are performed to evaluate incontinence. Surgery is then discussed.
If the surgery is performed in a private clinic, we will propose a date to you. If the surgery is performed in a private operating room, it is then planned in the Centre Métropolitain de Chirurgie, the only private hospital accredited in Quebec.
A blood work, an ECG and a preoperative meeting with a nurse are also necessary. She will be able to answer any additional questions you may have about the surgery.
Lastly, we need to obtain the approval of a CMC anesthesiologist to ensure your health allows general anesthesia.
If the surgery is performed in a private clinic, we will propose a date to you. If the surgery is performed in a private operating room, it is then planned in the Centre Métropolitain de Chirurgie, the only private hospital accredited in Quebec.
A blood work, an ECG and a preoperative meeting with a nurse are also necessary. She will be able to answer any additional questions you may have about the surgery.
Lastly, we need to obtain the approval of a CMC anesthesiologist to ensure your health allows general anesthesia.
What is a Single Incision Urethropexy?
The procedure is carried out under local anesthesia and sometimes with sedation. It can be performed at the hospital or in a minor operating room at the office. This technique is mainly designed for slim and physically active young women.
The polypropylene tape is small (3 cm long by 1 cm wide). It is anchored to the internal face of the obturating holes with small titanium anchors with a tunneler. The bladder is filled with around 300 cc of sterile water. The tape is then progressively adjusted in order to correct the incontinence caused by the patient’s spontaneous coughing. Sedation generally dissipates rather quickly. Most patients can return home approximately 2 hours after the procedure.
The benefits of this technique:
The polypropylene tape is small (3 cm long by 1 cm wide). It is anchored to the internal face of the obturating holes with small titanium anchors with a tunneler. The bladder is filled with around 300 cc of sterile water. The tape is then progressively adjusted in order to correct the incontinence caused by the patient’s spontaneous coughing. Sedation generally dissipates rather quickly. Most patients can return home approximately 2 hours after the procedure.
The benefits of this technique:
- Single Incision Urethropexy
- There is no general or spinal anesthesia
- There is no cutaneous incision, therefore no bandage
- There is no passing of the tape beyond the obturating membrane; therefore there is no risk to the adductor muscles of the thighThere is little post-operative pain
- You can resume normal activities more quickly (possibility of resuming most normal activities the very next day).
- No physical or sexual activity for 2 weeks
- Results are the same or very close to those obtained with TOT
What is Urethropexy with Trans-Obturator Tape (TOT)?
This intervention for stress urinary incontinence is performed under general anesthesia in a private hospital. It does not require hospitalization. It can be performed under local anesthesia in a private clinic. Dr. Marois makes a small vaginal incision and places the tape, the two branches of which are picked up by a tunneler via 2 incisions made above the pubis and left just under the skin.
The tape is therefore simply placed there, with no tension. Progressively, it will be colonized by tissue to which it will adhere. When pressure occurs, the tape provides a base for the urethra to rest on and keeps it from descending. Small bandages are placed on either side of the superior region of the vulva.
This surgery has many advantages:
The tape is therefore simply placed there, with no tension. Progressively, it will be colonized by tissue to which it will adhere. When pressure occurs, the tape provides a base for the urethra to rest on and keeps it from descending. Small bandages are placed on either side of the superior region of the vulva.
This surgery has many advantages:
- The surgery is quick and not very invasive
- The tape stays in place due to tissue colonization
- There are no sutures nor open retropubic intervention
- The vaginal incision measure one to two centimetres
- There is little risk of infection or of scarring problems
- It is performed in day surgery
- The convalescence period is 4 weeks
- It is indicated for elderly or heavier people due to all the above advantages
What are the possible risks and complications?
Practised since 1995, this technique has become the benchmark procedure for feminine stress incontinence. In most cases, there are not any postoperative complications. However, each surgery involves a number of risks and complications as described below:
The early and late risks and complications are generally minor:
If any complication or problem occurs outside our business hours, or if you are not able to join a secretary to make an appointment, please report to Verdun Hospital Emergency. The emergency physician will try to join Dr. Marois to get his report. Dr. Marois will then be able to give his recommendations over the telephone or will come to see you directly at the emergency room.
The early and late risks and complications are generally minor:
- Urethral trauma (0-1%)
- Preoperative hemorrhage over 300 ml (3%)
- Vascular incidents (very rare)
- Pain in the pelvis or legs 24 to 48 hours post-operation
- Urinary infection (4-22%)
- Defective vaginal scarring or erosion
- Local hematoma (1-2%)
- Late pain (from granuloma on the tape or periosteal inflammation)
- Urinary retention (1-27%)
- Frequent urination, urgency (13-15%)
- Post-operative dysuria, or weaker stream (30%)
If any complication or problem occurs outside our business hours, or if you are not able to join a secretary to make an appointment, please report to Verdun Hospital Emergency. The emergency physician will try to join Dr. Marois to get his report. Dr. Marois will then be able to give his recommendations over the telephone or will come to see you directly at the emergency room.
There is currently a moratorium issued by Le Collège des Médecins for the implantation of TOT incontinence mesh. At Les Cliniques Marois, patients can be advised about other valid alternatives, such as bulking agents and pelvic floor physical therap
Would you like to make an appointment, or do you have any questions? Write to us and we will get back to you as soon as possible!
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Cancellation policy
Dr. Marois is a urologist who is not a member of the Régie de l’Assurance Maladie du Québec (RAMQ). As such, if you require his professional services, you will have to pay directly the Cliniques Marois for the services rendered.
Cancellation Policy:
To ensure the smooth running of the clinics aa well as a minimum of courtesy towards other patients and staff members, we ask you to notify us 48 hours in advance for cancelling an appointment, 5 working days for cancelling a minor surgery in the office and 21 working days for major surgery at the CMC. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.
Change of appointment:
We understand that events occur and schedules change, so we ask patients to give us at least a 24-hour notice for any changes of appointment. We will be happy to reschedule another one for you. Failure to provide such notice within this timeframe will result in a $ 100 fee.
Thank you for your understanding.