Urinary Incontinence

Surgery is targeted at the symptom of stress incontinence and the condition of urodynamic stress incontinence. Surgery in this circumstance is generally effective with a 90% success rate.

Since 1998, when the Tension-free Vaginal Tape (TVT) came to Australia (Professor Haylen performed the first procedure in August that year), surgery for urinary incontinence has become minimally invasive, involving generally just an one or two nights stay in hospital and a relatively short recovery. 

Over 95% of Professor Haylen’s continence surgery involves the insertion of tapes, either alone or in conjunction with surgery for prolapse. There is a very limited role for the traditional abdominal continence procedure, called the colposuspension (also highly successful) if abdominal surgery is otherwise required (most commonly for a large fibroid uterus).

TENSIONLESS (Tensionfree) VAGINAL TAPES

Professor Haylen used the Gynecare “Tensionfree Vaginal Tape (TVT)” up to October 2005. In the last 12 years, he has only used Boston Scientific Tapes, firstly the Advantage Tape and, over the last 4 years, the more compact Advantage “Fit” Tape.

 Advantage “Fit” Tape: (Boston Scientific)

Professor Haylen has performed over 4500 tape procedures, to his knowledge, the largest series in Australia and one of the largest series worldwide.

Tape procedures, with or without prolapse or other procedures, are generally performed under a spinal (epidural) block. This allows for the patient to cough with a moderately full bladder after the tape has been inserted. This helps to ensure the adjustment (tension) of the tape is sufficient to stop the leakage. Hence, it contributes to a higher success rate for cure of the incontinence.

The main possible, and generally minor side-effects, of the tape procedures are:

  1. slowing of the urine flow (it may take longer to empty the bladder);
  2. (persistence of any urgency (tapes cannot be expected to cure urgency though around 50% patients find that symptom is improved;
  3. local bruising or bleeding around the operating sites
  4. local discomfort around the operating site.

Professor Haylen arranges for a surgical follow-up visit within 10 days of the procedure to make sure all is well. In a very small number of cases, adjustment of the tape is required. This needs to take place within the 14-16 days after surgery.

Light duties (lifting no more than 5Kg) are required in the first 10 days. Return to most work activities is allowed after this. Driving after the tape procedure is allowed after 4 days. There are vaginal sutures which dissolve over 3 weeks restricting intercourse (if applicable) over this time. Sporting activities can be resumed from 4 weeks post-op.

c ) Colposuspension

The permission of Brisbane urogynaecologist, A/Prof Chris Maher, to use his excellent drawing is gratefully acknowledged.

The colposuspension uses vaginal tissue to elevate the bladder neck. Stitches link the vagina to the strong ligaments overlying the pubis. This is a different way of curing incontinence from the tapes which are a sling to support the middle of the urethra. The colposuspension has been a very effective procedure since first developed by Burch in 1961.

 

© Copyright Bernard T. Haylen 2017