Frequently asked Questions
Q: I have had leakage for many years. Can I just have this sling and get it fixed ?
Before contemplating any treatment we need to ensure the diagnosis is right and your leakage will be fixed by this sling. This is done by asking lots of questions, an examination of the bladder and the support in the vagina and then some tests of bladder function. An ultrasound is done to exclude some other causes.
Q: I have done pelvic floor exercises for years with no result. Are you going to make me do them again ?
Maybe. Once know what is causing your problem we will look at the options for treatment. Every operation has a risk so we would prefer you to have looked at all other options before contemplating surgery, but at the end of the day the choice of treatment is up to you.
Q: What are the non surgical options ?
Depending on your diagnosis and what options are available non surgical treatments include:
- Electromagnetic induction therapy - click for more information
- Incontinence devices and pessaries - click her for more information
- Pelvic floor training - click her for more information
- Vaginal oestrogen - click her for more information
- Hormone supplements - click her for more information
Q: Why should I try these options first ?
In general they are safe and simple treatments whilst surgery has uncommon but serious side-effects.
Q: What are the arguments in favour of using this particular sling ?
This sling appears to do the same job as the more traditional sling but with a much smaller and safer procedure than before. There is much less risk of damage to blood vessels and the urethra and almost no risk of damage to the bladder or abdominal organs. The sling is also made from a superior mesh which has the important properties of a wide weave macroporous low density mesh but at the same time non elastic and easy to position against the urethra without retraction.
Q: What are the arguments against using the sling
- The sling is so new that nobody has any long term results and they might all fall out after a few months
- The sling is only 8cm long so it will not have much grip and will be moved when the patient gets back to normal activities
Q: Why are you offering me this sling if there is not enough evidence that it works.
A large number of these slings have been done by surgeons around the world and those surgeons that I have spoken to at conferences are very happy with the results so far. The new sling is definitely much safer and in my opinion will prove to be equally resilient to movement in the future if it has been put in correctly.
In my limited experience to date I agree with the claims of the manufactures as follows:
- Less invasive - there is a dramatic reduction in the amount of surgery. The sling penetrates only up to a maximum of 4cm on each side of the urethra. There is much less risk of trauma or bleeding.
- Less dissection - initial dissection is only 1-2 cm in total length
- Less anaesthesia - even local anaesthesia is possible
- Less pain - all of the patients that I have operated to date have reported no pain at all. There is no need for the sling to pass through the muscles of the abdomen or groin and there are no skin exits.
- Less complicated - the operative procedure is very simple and because of improvements in the tape itself there is less trouble actually adjusting the tape.
Q: How long does the operation take ?
About 10-15 minutes.
Q: Do I have to be asleep ?
No, but in Australia most patients have a general anaesthetic. This procedure can also be done under regional or local anaesthetic.
Q: What if I would like to have the old sling ?
No problem. In some clinical situations I will recommend the older sling (TVT, TVT-O, Monarc or IVS) where I am worried about the ability to place a TVT Secur correctly when the patient's anatomy indicates that a longer sling is needed. This will be decided on a case by case basis.
Q: What if this sling does not work ?
We have to work out why it didn't work and then decide what to do next. Sometimes the older slings do not work also. It may be because they were put in incorrectly or they have moved. If this has happened a repeat sling may be an option and this is no problem. On other occasions the sling is fine and the problem is due to some other problem like a poor quality urethra where a completely different treatment may be needed.
Q: Is there any way I can ask some questions without actually having to see the doctor ?
Yes. Telephone the main office in Wahroonga and ask to talk to Robyn, our nurse.