Normally, the striated sphincter muscle of the urethra, or the muscle responsible for controlling urination, performs a double function: when it contracts, it closes the urethra and holds urine in the bladder; when released, it opens the urethra and allows urination.
If this muscle does not work properly, as sometimes happens after surgery performed on the prostate, uncontrolled loss of urine occurs.
The “AdVance®” or urethral “sling”, consists of a suspension network in biocompatible material (prolene) which is implanted inside the body, leaving no trace of itself on the outside.
Once positioned, the sling represents a sort of support surface against which the urethra is compressed during effort, thus preventing urine leakage even (and above all) during activities that require physical effort (lifting heavy objects, physical exercise) or, for example, during a coughing fit.The sling is self-functioning.The surgery is minimally invasive. To allow placement of the sling, three skin incisions are made:– An incision (a few centimeters long) along the midline, in the perineum, or in the area immediately located below the scrotum.– Two lateral incisions (less than 0.5 cm long), located laterally with respect to the scrotum, near the inguino-scrotal folds. Through the two lateral incisions, the obturator foramen can be recognized, which is part of the ischio-pubic branch, in turn constituting the bones of the pelvis.Through these small incisions (and, in particular, through the obturator foramen) and with the help of a special instrument, the sling is positioned so that it surrounds the urethra, without being placed under tension.
The total duration of the procedure is approximately 60 minutes.
It is necessary to place the bladder catheter, which is removed during the first post-operative day, with spontaneous resumption of urination.
Convalescence
It lasts an average of 10 days. Starting from discharge, normal daily activities can be gradually resumed, provided that too violent efforts or lifting objects weighing more than 2-3 kilos are avoided. It is also advisable to avoid swimming in the sea and the use of bicycles and / or motorcycles for at least 2 months.
Bladder catheterizations
To ensure good bladder emptying, daily self-catheterizations must be performed. The manoeuvre, performed sterile, consists in inserting a small catheter into the bladder through the external urethral meatus and emptying the bladder itself. The medical and nursing staff will explain the correct method of execution. This maneuver must be performed once a day for the first 7 days after discharge, then it must be performed once a day for 10 days, but every other day.
The correct execution of self-catheterizations is of fundamental importance for the final outcome of the operation.
Sports activity and sexual activity
Both can be resumed gradually, and in any case, always after having discussed it with the Urologist.
The wound
The stitches of the perineal wound will reabsorb by themselves, within about 15-20 days, without the need for any mechanical removal. Only careful daily local hygiene and disinfection is recommended. You can take a shower starting 10 days after the operation (bathing in the tub is usually allowed about 20 days after the operation).
It is very important to disinfect the wound daily for at least 20 days after the operation. In fact, considering the site of the wound, there is a non-negligible risk of infection.
The two small wounds in the lateral groin will heal spontaneously in about 10 days.
Urinary tract infections
In order to avoid them, an antibiotic treatment will be administered for the period of convalescence. In the suspicion of a urinary tract infection, it is advisable to perform a complete urine test and a urine culture with antibiogram and ask the attending physician for any appropriate antibiotic therapy.
Perineal pain
Normally, post-operative pains are minimal, linked to the skin wound, and easily controlled with common analgesic treatment.
The positioning of the AdVance® does not prejudge the possibility of implementing other surgical options for the treatment of urinary incontinence, should it not prove effective.
In any case, in the event of hospitalisation, for any reason, inform the healthcare personnel that you are wearing an AdVance®, especially in anticipation of urethral catheterization manoeuvres.
Need for re-intervention
A reoperation may be necessary if an infection occurs at the site of the prosthetic implant. Reoperation is intended to remove the entire device.
In case of infection, once the prosthetic device has been removed, the tissues will be abundantly sprayed with antibiotic solution and any infected collections will be drained to the outside. It will absolutely not be possible to implant a new device during the same surgery, in order to avoid problems of superimposed infection. A new operation will be possible once the infection has adequately resolved.
