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.
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:
- 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 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:
- 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.