Information on Sub Urethral Slings
The Facts
Sub urethral slings are a minimally invasive procedures for treatment of stress incontinence. Any technique that involves surgery is subject to complications and risk, even death.
What is the surgery?
A suburethral sling aims to support the mid-urethra.
What is it actually trying to achieve?
The answer to this question is controversial. Some doctors believe that the sling reconstitutes the mid urethral ligament which enables the muscle forces that open and close the urethra to work more effectively. Others believe that the sling creates a hammock under the urethra so that abdominal pressure compresses the urethra against the new hammock.
Are there non surgery options to treat this problem ?
Before considering surgery all other Conservative Options should be considered.
Is this surgery the common surgery for this condition? What other options are available?
Sub urethral slings are now the gold standard surgery for treatment of stress incontinence. A number of different configurations are now available.
Traditional IVS
This is the original procedure. A number of excellent tapes are now available for performing this procedure. There is evidence to suggest that this is the preferred option for patients with ISD
TVT Obturator/Monarc
Transobturator application of a sling is currently the most popular suburethral sling that is available. This technique avoids the risk of damage to the bladder and bowel as the needle introducer does not pass through the abdominal cavity.
Dr Farnsworth has been undertaking a research study on the TVT Obturator procedure over the last few years. Click here if you would like to see the patient information sheet for this study.
TVT Secur
This is the latest option available. Click here for more information on TVT Secur
Consider the risks and benefits
How many similar surgeries has your doctor performed?
Dr Farnsworth has been performing and teaching techniques of sub urethral sling surgery for over 10 years. In this time he has performed over 800 retropubic slings (TVT and IVS), over 100 Transobturator Slings and since December 2006 he has performed 15 TVT Secur procedures.
How many of these operations are done at this hospital?
These procedures are performed each week at Sydney Adventist Hospital by a number of surgeons.
What is the success rate?
The average success rate is between 80-90% over allpatient groups but succes rates in patients with straightforward stress incontinence are closer to 90% Todate all of the TVT Secur procedures have been succesfull.
What does success mean to you and what does it mean to your doctor ?
We regard success as cure of incontinence as well as the associated improvement in quality of life.
What can go wrong ? How often does this happen ?
Complications include General Risks of a Procedure
- small areas of the lungs may collapse increasing the risk chest infection
- blood clots in the legs with pain and swelling - this can lead to a fatal embolism
- a heart attack or stroke
- death can result from the surgery
Specific Risks of the Procedure
- failure of the procedure
- post operative bladder dysfunction including overactivity, urgency, frequency, nocturia
- voiding difficulty which could lead to the need to divide or remove the tape
- infection
- excessive bleeding. This is rare
- mesh complications - erosion, infection, extrusion (less than 1%)
How will you feel after surgery?
Most patients describe very little pain after a sub urethral sling. Occasionally there can be discomfort associated with skin stitches causing irritation until they are removed or dissolve.
How long will it take until you are fully recovered?
Most patients are back to normal within a week or two. Full healing is not complete until 6-12 weeks.
How can you best prepare for the surgery and recovery period?
It is essential that you do nothing to compromise the operation in the first two weeks after surgery. This means no housework, no cooking, no lifting or travelling outside your home for the first two weeks.
Consider the costs
How much does the operation cost?
Dr Farnsworth follows the scale of fees published by the Australian Medical Association. Full consent and financial consent will be outlined when your surgery is booked.
How to make your decision
When talking to your doctor ask yourself how much does the problem really bother you ?
This is the key decision making question. The decision is a process of balancing the perceived benefits of the surgery against the potential risks of the procedure. Other questions that may be important in making your decision are listed below:
Are you willing to put up with the symptoms to avoid surgery ?
What are your concerns about the surgery?
Do you want to have the surgery at this time?
Would you like a second opinion?