Treatment / Autologous Pubovaginal Sling

Indication:

Autologous pubovaginal sling insertion is a surgical intervention primarily recommended for women suffering from stress urinary incontinence, a condition marked by the involuntary loss of urine during physical activities like coughing, sneezing, laughing, or exercising. In this procedure, a sling made from the patient’s own tissue (often a strip of rectus fascia from the abdomen or fascia lata from the thigh) is used to support the urethra and prevent unintended urine leakage.

Alternatives:

Before proceeding with surgery, it’s essential to explore non-surgical and other surgical options:

1. Pelvic Floor Exercises: Strengthening pelvic floor muscles through Kegel exercises can offer better control over urination.
2. Medications: Certain medications can help adjust the muscles that influence urine flow.
3. Pessaries: These are supportive devices placed inside the vagina to prop up the bladder.
4. Lifestyle Changes: Modifications such as weight management, fluid intake regulation, or evading specific triggers can aid in managing symptoms.
5. Other Surgical Procedures: Alternatives like tension-free vaginal tape (TVT) or colposuspension might suit some women. Please note that TVT operations using synthetic slings have been suspended in England and Wales since July 2018 and are not an available option. 

Operation Details:

Under general, regional, or local anaesthesia:

1. An incision is made in the lower abdomen to obtain the fascia (if using rectus fascia) or in the thigh (if using fascia lata).
2. Additional small incisions are made in the vagina and above the pubic bone.
3. The harvested tissue is shaped into a sling and positioned under the urethra.
4. The sling is then attached to the nearby tissues to ensure proper support for the urethra.
5. All incisions are sutured closed.

What to Expect:

• Duration: The surgery typically takes 1-3 hours.
• Hospital Stay: Most patients remain in the hospital for 1-2 days post-surgery.

Postoperative Course:

1. Activity: Initial limitations are expected. Avoid heavy lifting and rigorous activities for several weeks.
2. Pain Management: Mild to moderate pain or discomfort can occur. Pain relief medications will be provided.
3. Catheter: A urinary catheter may be needed for a brief period post-surgery.
4. Follow-up: Regular appointments will be scheduled to monitor healing and check for any complications.

Risks:

Every surgical intervention has associated risks. For the autologous pubovaginal sling procedure, potential risks include:

1. Urinary tract infections
2. Difficulty in completely emptying the bladder
3. Urinary urgency or increased frequency
4. Damage to nearby structures
5. Hematoma or bleeding
6. Erosion of the sling material
7. Anesthesia-related issues

Recovery:

• Full Recovery: Most patients fully recover within 6-8 weeks.
• Sexual Activity: Generally, it’s advised to wait for at least 6-8 weeks before resuming sexual activities.
• Driving: Consult with your surgeon, but most can resume driving in about 2-4 weeks.

Success Rate:

The autologous pubo-vaginal sling procedure boasts a commendable success rate, with approximately 85-95% of women noticing significant improvement or complete resolution of their incontinence symptoms post-surgery. Nevertheless, individual outcomes may vary based on personal factors and the surgeon’s expertise.

In Conclusion

Autologous pubo-vaginal sling insertion remains a tried-and-true solution for women grappling with stress urinary incontinence. Engage in a comprehensive discussion with your healthcare provider to ascertain the most suitable approach for you, considering the potential risks and advantages.