7 July 2021 Author : Manuela Costa Stress urinary incontinence is the involuntary loss of urine with efforts such as coughing, sneezing, laughing, pick up weights, exercise, among others. It is a common problem, affecting 1 in 3 women. It can be treated in several ways: Symptoms may improve with pelvic floor strengthening exercises and lifestyle changes; When these approaches do not work and the woman does not want to have more children, surgical treatment can be the solution; Surgery is the most successful treatment for stress urinary incontinence. Several techniques can be used in stress urinary incontinence surgery: The sling or suburethral prosthesis or TVT (tension-free vaginal tape) is the most used. How does the sling or suburethral prosthesis work? In this surgery, a polypropylene sling , approximately 1 cm wide, is placed between the middle region of the urethra (the channel through which urine flows from the bladder to the outside) and the vaginal mucosa. Over time, local tissues integrate the prosthesis through fibrosis. After a few weeks, healing is complete, keeping the prosthesis in its correct position. The prosthesis then starts to support the urethra , preventing involuntary urine loss associated with exertion, as it reinforces the action of muscles and ligaments weakened by childbirth or by the normal aging process. How is the surgery performed? The surgery is performed in the operating room , under general or locoregional anesthesia and with the patient catheterized. The type of anesthesia depends on the recommendations of the anesthetist, the particularities of the case and the preferences of both surgeon and patient. The prosthesis is placed through an approximately 1 cm incision made at the site of the vagina under the mid-urethra region. Using proper needles that will come out behind the public bone (retropublic) or close to the groin (transobturator) the prosthesis is then adjusted, without tension, and, finally, the incision is sutured. Risks and complications of surgery Any surgery has risks and possible complications, which are related to the procedure itself and to the age, general health, and specificities of each woman. In the case of suburethral sling , the following may occur: Urinary infections, with symptoms such as burning sensation when urinating, need to urinate frequently, presence of blood in the urine or change in the odor of the urine, which require medical evaluation for the treatment institution. Difficulty in completely emptying the bladder, a problem that resolves spontaneously in about a week. Perforation of the urethra or bladder during surgery, described in about 1% of cases. Vaginal bleeding, usually self-limiting and not requiring intervention. In 1% of cases, erosion of the prosthesis, which means appearing through the vaginal wall. When this happens there is usually a stinging sensation, bloody discharge, and difficulty in intercourse. It can happen weeks, months or years after surgery and usually requires surgery to remove the prosthesis in the area where erosion has occurred. In 10% of cases: pain in the vaginal and groin area after surgery that resolves within 1-2 weeks. If it persists long term, which is rare, it may be necessary to remove the prosthesis. Worsening urinary urgency symptoms in 5% of women who suffered from mixed urinary incontinence. Failure to resolve symptoms of stress incontinence in 10%-20% of cases. Hospital discharge and return to daily activities Usually, hospital discharge is possible the day after surgery if the patient can urinate normally and there are no other contraindications. About a week after discharge , daily routines, including driving, can usually be resumed. However, the practice of physical activity and efforts, including carrying weights, and sexual intercourse should be avoided for about 6 weeks and all specific medical indications respected . Only then will it be possible to heal and fix the sling in the correct position. Treatment success In 80%-90% of cases the symptoms of stress urinary incontinence resolve or improve with surgery, with patients remaining without complaints for several years. The previous performance of bladder surgery decreases the probability of success. Other frequently asked questions Meet the obstetrics-gynecology team from Hospital da Luz network and book your consultation The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
