Colposuspension for stress urinary incontinence

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1 Colposuspension for stress urinary incontinence Information for patients This leaflet sheet answers some of the questions you may have about colposuspension. It explains the benefits, the risks and the alternatives, as well as what you can expect when you come to hospital. If you have any questions or concerns, please do not hesitate to speak to the doctors or nurses caring for you. What is stress urinary incontinence? Stress urinary incontinence is the sudden, accidental loss of urine when you do everyday things such as coughing, sneezing or laughing. It happens when the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra (the tube through which urine passes out of your body) to stay closed. Your urethra may not be able to stay closed if your pelvic floor muscles are weak or damaged, or the ring of muscle that keeps the urethra closed is damaged. What is colposuspension? Colposuspension involves having stitches put in to support the neck of your bladder so it cannot move about and cause stress urinary incontinence. It has been used to treat the condition for more than 40 years so there is a

2 lot of information about how well it works and whether it lasts. You usually have it through a cut in your bikini line on your abdomen (tummy), but it can also sometimes be done with keyhole surgery which means we only need to make very small cuts. Why do I need this procedure? You have been diagnosed with stress urinary incontinence. Colposuspension is one of a number of ways of treating this condition. We explain some of the alternative treatments in this. Your doctor has looked at your diagnosis, medical problems and any treatments you have tried in the past and decided that colposuspension will work best for you. What are the benefits? More than 80% of women who have not had an operation for stress urinary incontinence before are cured by a colposuspension. This means that if 100 women had a colposuspension, 80 of them would feel that they had been cured and 20 would feel that they had not been cured. However, 20 years after their operation, only 60 out of 100 would feel that they had been cured. You can have this procedure at the same time as an abdominal hysterectomy. It is suitable if you have had surgery for stress urinary incontinence before which has failed. What are the risks? As with any treatment, there are some risks. It is important to discuss these risks and side effects with your doctor before the procedure. The following complications can sometimes happen after the procedure: 1) Procedure does not work No operation for urinary stress incontinence works for everyone. 2) Overactive bladder Your bladder may become irritable or overactive. After a colposuspension, 17 in every 100 women (17%) need to rush to the toilet or pass urine more often. Sometimes an overactive bladder can make you leak urine because you cannot get to the toilet in time. This can be managed with bladder retraining and medication.

3 3) Prolapse A prolapse is a bulge in your vagina caused by its walls sagging. It is very common and often does not cause you any problems or need any treatment. About 14 in every 100 women (14%) who have had a colposuspension operation will develop a prolapse in the back wall of their vagina (rectocele) within five years. It might be small and not need any treatment. If it does need treating, you may be able to use a vaginal pessary or have an operation. 4) Difficulty passing urine You might notice that your urine flow is different. Sometimes it is slower and you may have to change position on the toilet such as leaning forward to empty your bladder completely to get out the last of the urine (see point five). About 10 in every 100 women (10%) have problems emptying their bladder after the operation (see point number five). 5) Problems emptying your bladder You may find it difficult to empty your bladder after your operation. This may get better, but in a small number of women it lasts forever. It is normal to leave behind a small bit of urine after going to the loo. We call this the residual volume. But if too much is left behind it can lead to problems such as having to go to the toilet too often and bladder infections. If the residual volume is too high, we may need to teach you a way of emptying the urine left behind. This is called clean intermittent self-catheterisation (CISC) and involves putting a small catheter into your urethra to empty your bladder. Once the urine is out, you can take out the catheter and throw it away. Most women need to do this about twice per day. 6) Pain during sexual intercourse This can happen after any operation where you have stitches near your vagina. About five in every 100 women (5%) find sex uncomfortable or painful after a colposuspension. Sometimes you may have less sensation during intercourse and your orgasm may be less intense. 7) Problems with the stitches In a very small number of women, the stitches holding the neck of the bladder in place cause problems. Over time they can wear through to the inside of your bladder. This is very rare. 8) Risk of general anaesthetic

4 Although there is a risk of problems with a general anaesthetic, this is very small. 9) Bleeding There is a risk of bleeding (haemorrhage) which may mean you need to have a blood transfusion. 10) Blood clots (thrombosis/pulmonary embolism) A thrombosis is a blood clot that forms inside a vein and stops your blood from flowing normally. A pulmonary embolism is a blood clot that forms in your lungs and can affect your breathing. You are at greater risk of blood clots these if you stay still or lying down for a long time. To help prevent them, we will give you a small injection once or twice a day, depending on your weight. We will encourage you to start moving around and help you to get out of bed on the day after your operation. We may also give you special antiembolism stockings to wear, to help reduce your chance of deep vein thrombosis (DVT) and to increase the blood flow in your legs. 11) Infection You may develop a urine or a chest infection after the operation. We will give you antibiotics to treat any infection. Are there any alternatives? There are a number of other treatments for stress urinary incontinence. These include: Pelvic floor muscle training Your pelvic floor is a broad sling of muscle which stretches like a hammock from your pubic bone in the front, to the bottom of your spine at the back. These firm, supportive muscles help to hold your bladder, womb, vaginal walls and bowel in place. They close your bladder outlet (urethra) and your back passage (anus) to stop urine, faeces and wind/gas leaking out. When these muscles are weak, you may start to leak urine, or find it difficult to control wind or hold on when you need to open your bowels; in some cases your pelvic organs can drop down. The weakness is usually caused by childbirth, heavy lifting or constipation. These muscles can also become weaker during the menopause. It is important to do pelvic floor muscle exercises regularly to build them up and prevent urine from leaking.

5 Depending on how severe your stress incontinence is, you may find pelvic floor muscle exercises are enough to improve your symptoms. Intra-vaginal devices You can have a small device called a vaginal pessary, which is similar to a diaphragm or a cervical cap, put in to your vagina to hold prolapsed organ(s) in place. It is also used for stress urinary incontinence. Pessaries must be individually fitted and you may need to try a few different shapes and sizes before you find one that feels comfortable and stays in place. Tension-free vaginal tape This involves putting a synthetic tape through a small cut in your vagina. The tape is looped around the outside of your urethra and the two ends come out through two very small cuts in your pubic area and are then trimmed. The tape does not dissolve and stays inside you forever. You can have this procedure as day surgery. It is a smaller operation than colposuspension and you recover more quickly. Consent We must by law obtain your written consent to any operation and some other procedures beforehand. Staff will explain the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure of any aspect of the treatment proposed, please do not hesitate to speak with a senior member of the staff again. Do I need to prepare for the procedure? You will have a pre-assessment appointment before your surgery to check you are well enough to have the procedure. What happens at a pre-assessment appointment? At this you may have tests such as blood tests, an electrocardiogram (ECG) to check your heart and a chest x-ray. The pre-assessment nurse will explain what happens during your operation and the care you need afterwards. You will see the medical team to complete a consent form. You will have the chance to talk to them about the procedure and ask questions.

6 When will I have my pre-assessment? If you are a patient of Professor Cardozo or Mr Robinson, we will ask you to come to your pre-assessment appointment on the Monday or Thursday before your surgery. If you live a long way from the hospital or have certain medical problems (such as diabetes) you will stay in overnight and have your planned surgery the next day (Tuesday or Friday). Otherwise you will be admitted on the morning of your surgery. The pre-assessment nurse will give you all the details you need. If you are a patient of Mr Bidmead or Miss Srikrishna, you will have your pre-assessment on the Thursday or Friday before your surgery. You will usually be admitted on the morning of your operation. Where will I have the procedure? You will have the surgery in one of our main operating theatres. You are usually admitted to the gynaecology ward on the day of your operation. What happens before the procedure? The evening before your operation you need to take a laxative called Picolax by mouth. This should give you loose stools and make your bowels open. We will give you an enema on the morning of your surgery if you have not opened your bowels. What happens during the procedure? You have the operation under a general anaesthetic, so you will be asleep. Your doctor will make a 10cm (4in) cut along your bikini line on your abdomen (tummy). They will open up your tummy to reach your bladder. They will put stitches in the walls of your vagina, on either side of the neck or your bladder and sometimes at its base. They will tie the stitches to strong fibrous tissue just behind your pubic bone. They will leave in a fine plastic tube (a drain) to draw-off any spilled blood. They will stitch up the cut in your tummy and may put a catheter (tube) through the wall of your tummy and into your bladder. This is called a suprapubic catheter and allows your bladder to rest while it recovers from the surgery.

7 Will I feel any pain? You have the operation under a general anaesthetic so you will not feel anything. The wound is not normally very painful but you may need some painkilling tablets or injections after the operation. How long will the procedure take? It takes about 1 to 1.5 hours. What happens after the procedure? You usually stay in hospital for two three days after the operation. When you are taken back to the ward you will have a drip (fine tube) in one of the veins in your arm that gives you fluid to stop you from getting dehydrated. If you have not had a suprapubic catheter put in, you will have a catheter in your urethra overnight to drain urine from your bladder. This may make you feel like you need to pass urine but do not worry your urine will drain into a special bag. We usually take out the drip and catheter in your urethra the morning after surgery. If you are unable to pass urine you may need to go home with the catheter in placesometimes you may have both a suprapubic and a urethral catheter after the op and one will be removed before you go home. If you go home with a catheter you will come back after two weeks to see if you can pass urine normally. The day after the operation we will encourage you to get out of bed and take short walks around the ward. This improves your general wellbeing and makes you less likely to get blood clots in your legs. We usually give you an injection once a day to keep your blood thin and cut your risk of blood clots. You normally have these until you go home but you may need to have them for longer. You will have slight vaginal bleeding a bit like the end of a period. This may last for a few weeks. It usually takes six eight weeks to recover from the procedure. The nurses will advise you how to get a sick certificate if you need one.

8 What should I do if I cannot attend my appointment? Please contact the gynaecology admissions team. Tel: Who do I contact with queries and concerns? If you have any problems within hours of leaving hospital, please call Katherine Monk ward and ask to speak to the ambulatory nurse or the nurse in charge of the ward. Tel: If you have any problems after 48 hours, please contact your GP. If you need urgent medical attention, go straight to your local Emergency Department (ED/A&E). If you have any other queries or concerns, please phone the Urogynaecology Department. Tel: , 9am 5pm, Monday to Friday. Sharing your information We have teamed up with Guy's and St Thomas' Hospitals in a partnership known as King s Health Partners Academic Health Sciences Centre. We are working together to give our patients the best possible care, so you might find we invite you for appointments at Guy's or St Thomas'. To make sure everyone you meet always has the most up-to-date information about your health, we may share information about you between the hospitals. Care provided by students King s is a teaching hospital where our students get practical experience by treating patients. Please tell your doctor or nurse if you do not want students to be involved in your care. Your treatment will not be affected by your decision. PALS The Patient Advice and Liaison Service (PALS) is a service that offers support, information and assistance to patients, relatives and visitors.

9 They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. The PALS office is located on the ground floor of the Hambleden Wing, near the main entrance on Bessemer Road - staff will be happy to direct you. Tel: Textphone: Fax: If you would like the information in this leaflet in a different language or format, please contact PALS on Corporate Comms: 0660 PL614.1 October 2013 Review date October 2016

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