Stress Urinary Incontinence (SUI) occurs when an increase in intra-abdominal pressure exceeds urethral closure pressure, resulting in the involuntary leakage of urine. This may occur with physical exertion, sneezing, laughing or coughing. SUI affects 4 to 35 percent of women. Midurethral tape procedures, such as TVT (Tension-free Vaginal Tape) or TOT (Trans-Obturator Tape), are commonly used to treat stress urinary incontinence. The sling is intended to correct ONLY stress incontinence (urine loss with laughing, coughing, sneezing, exercise, and physical activity). Urge incontinence (urine loss with a sudden urge to urinate) may not improve after a sling procedure. If urgency incontinence persists after surgery, pelvic floor physiotherapy, medications, or additional procedures may be recommended.
The procedure involves placing a narrow strip of synthetic mesh under the urethra. The tape acts like a hammock providing support to the urethra and help prevent leakage during moments of pressure. Surgery is usually performed under a general or spinal anaesthetic and involves an overnight hospital stay. Midurethral tape procedures are considered effective and minimally invasive with high success rates. Most women recover quickly and experience a significant improvement in bladder control.
Pre-op
- Please follow the Pre-Operative checklist page for more details.
- Have your pre-op blood test 1 week before your surgery. If ECG is requested, please do the test.
- Avoid constipation in the days leading up to your operation. If needed take a stool softener/laxative eg. Movicol, Fybogel.
- Prepare for your post op recovery by stocking up your pantry and your freezer with some cooked meals.
Post-op
- Hospital stay: After your surgery you will typically stay in hospital only 1 night. Before you go home, ideally you should be able to walk around by yourself, tolerate normal drinking and eating, pass urine normally and have passed wind.
- Pain: It is normal to experience pain around your incisions or in the pelvis. Continue your painkillers provided by the hospital regularly to keep your pain well controlled.
- Vaginal discharge and bleeding: Vaginal spotting (light bleeding) and discharge are normal after your surgery and may persist for up to 6 weeks. These symptoms are due to dissolving stitches and the healing of your incisions. Your stitches will not need to be removed as they are dissolvable. You may notice a stitch, or part of a stitch, coming away after a few days or maybe after a few weeks. This is normal and nothing to worry about. We recommend wearing a pad after surgery; please do NOT use tampons.
- Exercise and Physical activity: Walking is encouraged starting on the Day of Surgery. It gives you good cardiovascular benefits and helps your body heal! You can walk on level ground as much as you want to. Bring your TED stockings home which are provided by the hospital and continue to wear them until you are fully mobile again. Gradually increase your usual level of activity as your body permits. It is perfectly safe to resume normal daily living activities – listen to your body. Avoid excessive bending, lifting, Gym and heavy housework/strenuous activities for 4 -6 weeks.
- Bowel care: Keep your fluid intake up (especially water) and mobilise. Eat healthy fibre rich diet to avoid constipation and straining. It is best to take a stool softener/laxative eg. Movicol, Fybogel until your bowel functions and regular.
- Shower and Bath: Shower as soon as you are comfortable enough to do so. Do not scrub any external incisions or pick at any surgical glue. Washing the labia with warm water is fine, but nothing should go inside the vagina. Avoid swimming in a public pool for 4 weeks to reduce the risk of infections. Swimming in your own pool or ocean is acceptable after 2 weeks.
- Driving: Most patients can drive 1-2 weeks after having surgery. Please do NOT drive if you are taking opioid pain medication or your body doesn’t feel ready to perform an emergency stop without causing pain.
Please check your car insurance policy for specific post-surgical requirements. Always follow your insurer’s advice if they require a longer recovery period before driving. - Return to work: You may return to work if your job does not involve repetitive lifting or straining (Desk job) as soon as you feel ready, usually within 2 weeks. If your job involves physically demanding activities, you may need 4-6 weeks.
- Intercourse: Avoid intercourse for 6 weeks to allow complete healing of the vaginal incision. Sexual activity can disrupt the sutures in the vagina, as well as significantly increase intra-abdominal pressure.
- Vaginal Oestrogen: You may recommence using vaginal oestrogen (e.g. Ovestin, Vagifem) 2 – 3 weeks post-op if it feels comfortable.
- Abdominal incisions: You will have 2 small incisions just above the pubic bone, closed with either sutures or glue. Surgical glue is waterproof and will come off naturally. There will usually be no dressings on these wounds. If there are, the dressings can be removed after 48 hours. Wounds can be gently washed with soap and water.
- Catheter Use: A very small percentage of patients are discharged with a catheter. The nursing staff at the hospital will teach you about the catheter and give you all necessary supplies before you go home.
- If you go home with a catheter, an appointment will be organised at the hospital approximately one week after surgery to take the catheter out and have a voiding trial.
- When you have the catheter in place, the tube can be attached to a leg bag so that you can move around with ease.
- Make sure you empty the bag every time it fills up and before you go to bed at night.
What post-operative follow up will I have?
- Dr Zachariah will visit you in the hospital on post-operative Day 1. A discharge plan will be made. Please remember, the least number of days in the hospital is the best for you.
- You will receive a call from Carolyn, Dr Zachariah’s Nurse 5 -7 days after surgery to check on your progress. If you have any concerns, you may discuss with Carolyn.
- You will have a follow up appointment with Dr Zachariah in person 6 weeks after surgery. In the meantime, if you have any concerns, you may call the rooms. We will make every effort to resolve your concerns. You will have a second appointment organised at 6 months post op to assess your progress.
Potential Complications after discharge:
- You have heavy vaginal bleeding – heavier than a normal period.
- You have offensive or abnormal vaginal discharge.
- You develop a fever i.e., temperature >380 C, or you are feeling unwell.
- You have pain that is not relieved by simple analgesia.
- Nausea and vomiting that is difficult to manage.
- You are having difficulty passing urine or opening your bowels.
- Swelling in an extremity (leg or arm) that is much greater on one side than the other.
- Shortness of breath or chest pain.
Contact
- For post-operative complications as listed above please contact Dr Zachariah’s rooms on 08 9389 5000.
- During out of hours or weekends please call Hollywood Hospital Switch board on 08 9346 6000 and ask to speak with the Nurse Co-ordinator who will liaise with Dr Zachariah.
- For non-urgent matters, please contact your GP.