UROLOGICAL SURGERY
Positioning of Sling TOP for female incontinence
Positioning of Sling TOP for female incontinence
Urinary incontinence, or the involuntary loss of urine, is a problem that affects over 3 million Italians (7.8% of the general population). Women are more affected than men, due to childbirth (which can alter the structure of the tissues surrounding the vagina), menopause, individual predisposition and obesity.
However, incontinence often seriously compromises the quality of life of patients, in various areas: social, psychological, professional, domestic, physical, sexual.
There are different types of incontinence, including stress incontinence, which manifests itself for example when coughing, laughing, running. It can be treated effectively with surgery. This type of intervention falls within the scope of minimally invasive surgery for the treatment of stress incontinence. Compared to the traditional surgical technique called T.V.T. (Tension-free trans-Vaginal Tape), the T.O.T. (Trans-Obturatorial Tape), by virtue of the minor surgical invasiveness, presents a lower risk of damage to the bladder and hemorrhage. Therefore, many Centers are starting to use this surgical technique on a par with T.V.T. According to data published by various authors, including Italian ones, this technique is extremely effective: the success rates are over 90%, regardless of the center where the operation is performed. Furthermore, reassuring information relating to the results 5-7 years after the intervention is being developed, such as to confirm the effectiveness of the procedure over time. Most patients report complete resolution of the problem (absolute absence of stress incontinence). A small proportion of patients report a significant improvement in the condition such that any modest urine losses are no longer considered a cause of discomfort. The percentage of cases in which the intervention does not lead to any significant improvement is still under study and is, in any case, around 5%.
Placing a T.O.T. provides for a series of clinical and instrumental tests, to be performed before hospitalization, including: blood tests, urine test with urine culture, PAD test/wet diaper weight, urethrocystoscopy, complete urodynamic examination and possibly ultrasound of the urinary tract and retrograde and voiding cystourethrography
The length of hospitalization is approximately 72-96 hours.
OUTLINE OF SURGICAL TECHNIQUE
Anesthesia
The operation is performed under “loco-regional” anesthesia, i.e. by means of a small injection of anesthetic at the level of the spine (scientifically defined as spinal injection). This type of anesthesia allows you to be awake while the surgery is being performed.
The surgery is minimally invasive.
3 incisions are made, with a diameter of about 1 cm: 1 located 1 cm below the external urethral meatus; 2 lateral to the labia majora. 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) a band (the “Tape”), made of a biocompatible material (polypropylene), is positioned with a special instrument. This bandage is placed, without tension, so as to surround the urethra.
A possible control cystoscopy, performed during the operation, will allow to verify the integrity of the bladder. Furthermore, the surgeon will directly verify the effective support of the urethra through this device (and, therefore, the continence under stress), inviting the patient to perform coughs in the final stages of the operation itself and thus guaranteeing continence under stress. After the closure of the incisions, the band will remain in place by simple friction, without fixing, thanks to its roughness alone. Furthermore, it will maintain its resistance over time while adapting to the stresses of the body.
The total duration of the intervention is approximately 45-60 minutes.
Often it is not necessary to place the bladder catheter. If necessary, this is removed during the first post-operative day, with spontaneous resumption of urination.
USEFUL TIPS FOR DISCHARGE
Convalescence
it lasts about 10 days on average.
Physical activity
Starting from discharge, normal daily activities can be gradually resumed, provided one avoids excessively violent efforts such as lifting objects and bags heavier than 2-3 kilos.
Sports activity and sexual activity
They can be resumed 4 weeks after surgery, and preferably after the follow-up visit.
The wound
The stitches of the skin wounds reabsorb by themselves, without the need for any removal. You can take a shower starting 7 days after the operation (bathing in the tub is allowed about 20 days after the operation). Hematomas may form around where the needles pass into the pelvic muscle elements. These hematomas tend to reabsorb on their own as the days go by.
Urinary tract infections
An antibiotic treatment is administered for the convalescent period, to avoid infections. If you suspect a urinary tract infection, we recommend performing a complete urine test and a urine culture with antibiogram and asking your doctor for any appropriate antibiotic therapy.
Abdominal pain
If present, post-operative pains are minimal and easily controllable with a common analgesic treatment.
Need for reoperation
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.
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Florence | Matteotti Medical Group
Viale Giacomo Matteotti, 42
50132 – Florence (FI)
Telephone: 055 570224
Florence Castello | Villa Donatello
Via Attilio Ragionieri, 101
50019 – Sesto Fiorentino (FI)
Telephone: 055 50975
Prato | Studi Medici Life
Viale della Repubblica, 141
59100 – Prato (PO)
Telephone: 0574 583501
Milan | Columbus Clinic Center
Via Michelangelo Buonarroti, 48
20145 – Milan (MI)
Telephone: 02 480801
Dr. Andrea Cocci
urologist and andrologist
The decision to dedicate my professional life to urology and in particular to andrological and reconstructive surgery is the result of a deep passion for anatomy , the art of surgery and in general the diagnostic-therapeutic process which leads to the recovery of the patient. Oncological pathology, infertility, erectile dysfunction, penile diseases or simply prostate disorders irreparably afflict not only the individual but also the couple dimension.
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