Microsoft word - sling colposuspension _booklet, version 1 -8.06.06_.doc

Sling colposuspension is an operation to treat stress urinary incontinence. Stress incontinence is leakage of urine that occurs with activities which cause an increase in abdominal pressure such as coughing, sneezing, jumping, lifting, exercising and in some cases walking. This leakage occurs because the muscles at the bladder neck have lost their supports and strength. As a valve mechanism the urethra (outlet pipe) no longer stays closed when extra pressure is put on the bladder. This booklet is designed to give you an overview of the surgery and what you may expect whilst in hospital and following discharge. Sling Colposuspension

In this operation a strip of tissue is taken from the lower abdomen
and used as a sling or hammock around the bladder neck and
urethra and is then stitched to the surrounding muscles for support
while the sling heals into place.
The tissue to create the sling is obtained through an incision in the
bikini line and then placed in position through an incision in the
vagina.
On average most women are in hospital 4 to 5 days
following this type of surgery.
What happens before my operation?
The operation and possible complications will be explained to you
by the doctor. When you feel comfortable that you understand
what is to be done and have had all your questions answered you
will be asked to sign a consent form.

In the weeks just prior to surgery it is common to come to Urology
Associates’ pre-admission clinic to see the continence advisor.
You often have a routine blood test, a urine sample taken and a
chest xray requested. Depending on your age and other medical
problems you may also have an electrocardiogram (ECG) to
record the electrical activity of your heart.
If you were not booked to attend the pre-admission clinic these
tests will be done when you are admitted to the ward before your
surgery.
Try to establish and maintain a regular, soft bowel habit leading up
to your operation. Identify the foods that can help you in this area
for your post op period. It is important to avoid constipation.
What happens on the day of my operation?
You will be advised when to come to hospital and on arrival to the
ward the staff will show you to your bed and guide you through
what is required prior to your operation.
It is usual to stop eating and drinking at least 6 to 8 hours prior to surgery You should bring your own medications with you and the staff will advise you if you need to take them on the day of your operation. An area from the tummy button, to below the bikini line will be shaved in preparation for surgery. Before the operation you will be given supportive stockings to wear until you leave hospital to minimise the risk of blood clots forming. A blood thinning medication may also be prescribed. Just prior to surgery you may be given a premedication tablet to relax you. This and whether you have a spinal or general anaesthetic will be decided after discussion with the anaesthetist. This usually occurs during your pre-admission assessment or in the ward pre-operatively. You will be encouraged to commence deep breathing and coughing exercises to prevent any breathing complications or chest infection occurring following the surgery and anaesthetic. What may I expect after my operation?

When you first wake you will be in the recovery ward. You may feel
sleepy and perhaps a little disorientated, but this feeling soon
goes.
You may eat and drink as desired but initially it is better to start
slowly with fluids as the anaesthetic often makes people feel
nauseated. There is medication available to control this if
necessary.
An intravenous line (drip) will be attached to your arm for one or
two days to supplement your oral intake and to allow pain
medication to be given.
There will be a light dressing on your lower abdomen.
You will have a fine tube (catheter) in your bladder via your
urethra, draining the urine into a catheter bag.
What may I expect in the days after my operation?
While in hospital you will be prescribed panadol and you should
take this regularly to keep any discomfort to a minimum. Stronger
medication is available if required.

The day following surgery you will be assisted to shower and then
encouraged to sit in a chair at least twice during the day.
Mobilisation will minimise the risk of complications.
If a gauze pack was placed in the vagina during surgery it will
usually be removed the next morning prior to your shower.
Once you are drinking normally and your pain is controlled your
drip will be removed. This is usually 2 to 3 days after your
operation.
Your urethral catheter will also be removed after 2 to 3 days. After
a normal intake of fluid it is usual to pass urine every 3 to 4 hours.
Initially you should not wait longer than this before trying to empty
your bladder.
You may find emptying your bladder feels different as it recovers
from the surgery and the associated swelling of the surrounding
tissues.
Try to relax your abdominal muscles and the muscles underneath
your bladder. Take your time and just let the urine flow out.
Do not push or strain as this forces the urethra against the sling,
closing it off and stopping the flow of urine.
It is common not to be able to pass urine afterward.
If you cannot pass urine, pass only a small amount or have bladder discomfort please let your nurse know. The nurse will use an ultrasound bladder scanner to record the volume of urine retained. This is called the residual urine. If this volume is significant then it might be necessary for you to learn how to pass a catheter into the urethra to empty the bladder. This is called Clean Intermittent Catheterisation (C.I.C.) and can be performed in the privacy of your own bathroom or any toilet. Initially you may have to catheterise each time you need to pass urine but as things return to normal the frequency of your C.I.C. will be reduced. If needed your nurse will give you a booklet, which outlines this technique and will help you in learning C.I.C. When you feel confident inserting the catheter you can be discharged home. If you are unable to do C.I.C, you will be discharged home with an indwelling urethral catheter (I.D.C.). Your surgeon will decide when this should be removed. Following surgery it is important to avoid any abdominal straining while your surgical repair heals. In particular you must avoid lifting (5kg or more), bending and straining. You may be offered home help for the first few weeks after discharge. This is usually provided by the District Nursing Service and will be arranged by the ward nurse on your behalf. Keeping a regular, soft bowel motion is important. While in hospital you will be prescribed a laxative such as lactulose to help avoid this. Kiwi fruit or "kiwi-crush" are also recommended. Discharge Advice
You must not drive any vehicle or operate any machinery
for 24 hours after having an anaesthetic. You will have to
arrange for someone to drive you home if you go home
within 24 hours of your surgery.
Going home
• Many people are able to empty the bladder in the normal way. • If self catheterisation. is needed you will be given some • If going home with an I.D.C. you will be given a leg bag and 2 • If you are discharged with an I.D.C. your nurse will make an appointment for you to come back to the ward or clinic to have it removed. This may be one or two weeks later. • If needed, your ward nurse or continence advisor will arrange further catheter supplies and they can be obtained from The Nurse Maude Association Supply Department. Pain control
• Take regular pain control. Paracetamol (Panadol) or anti- inflammatory medication such as Diclofenac (Voltaren) or Neurofen are usually effective. • The more you do, the worse any pain will get, so use that as a guide for the amount of activity that you do over the next few weeks. • Wound pain sometimes may be worse on one side than the Wound care
• Your abdominal and vaginal wounds should heal within 7 to 10 days however the muscle layer beneath your skin will take up to 3 months to heal. • Keep your abdominal wound as clean as possible and dry it well after a shower. The dressing tape can be removed at anytime. • If you notice the wound becomes inflamed, there is an increase in pain or it is red, hot or swollen contact your GP for advice. Vaginal discharge
• It is normal to have some vaginal bleeding on and off for a few weeks and then a brown discharge for a few weeks following that. If the bleeding becomes heavy, you pass clots or have a smelly vaginal discharge, contact your GP. • You may also notice the remains of some stitches in your underwear or in the toilet after voiding. Do not be concerned as these are vaginal stitches which have started to dissolve and that is expected. Seek help if you develop
• ‘flu like symptoms • a temperature over 38*C • pain or discomfort not controlled by pain medication • bleeding or difficulty passing urine • pain or tenderness in the calf or thigh • symptoms of a urinary tract infection Change in voiding habits
• Following surgery you may find that your urinary stream does not start to flow immediately. The stream may be weaker, deviate or tend to stop and start. • You may also notice that your usual toileting posture changes. • These problems are not usually permanent and will resolve over Activity
• Initially when you go home you will not feel like doing very much, so listen to your body and rest. Sitting with your feet elevated will be the most comfortable position. • Showering • Preparing light meals • Walking up and down stairs slowly • Gentle walking is to be encouraged – it is better to do two short walks in the day rather than one long walk Things that you should not do for 6 weeks include • Picking up objects off the floor • Housework except light work at bench height • Vacuuming • Carrying supermarket bags / rubbish bags • Prolonged standing • Carrying children / pets Things that you should not do for 12 weeks include • Heavy lifting • Shifting the furniture • Lawn mowing or digging the garden • Weights at the gym • Carrying rubbish bags or washing baskets • Carrying children / pets Sexual intercourse
• You can resume sexual intercourse at 6 weeks but some women may need to adopt alternative positions if they experience any discomfort. You can discuss this with your specialist. • Generally when you feel that you could perform an emergency stop without being concerned about abdominal pain (at about 3 to 4 weeks), then you can resume driving. Returning to work
• Ask your specialist about returning to work. This will vary according to the type of operation performed and whether you have a manual or sedentary occupation. • Usually people are off work for about 4 to 6 weeks. Pelvic floor exercises
• It is important to recommence pelvic floor exercises once you • If you have any concerns about your technique please contact General health
• You may eat and drink normally. • Bowels – try to keep your bowel motions soft by using high fibre foods such as kiwi fruit, fruit, vegetables, wholemeal bread, nuts and seeds. • Do not become constipated or strain to have a bowel motion. • Use a footstool to help bowel emptying. Discuss this with your continence advisor if you need further information. • Take an oral laxative if you are constipated and conservative Follow up
The hospital continence advisor will contact you regularly by phone
to check on your progress. If you have any concerns you may ring
anytime or make a time to be seen in person.
You will also receive an appointment to see your specialist. This is
usually about 6 weeks following your surgery.
Sling Colposuspension (booklet, version 1 -8.06.06).doc

Source: http://www.urology.co.nz/documents/sling_colposuspension.pdf