Leaking urine? Anti-incontinence surgery can cure

Author: Lou Wenjia Peking Union Medical College Hospital

Reviewer: Zhu Lan, Chief Physician, Professor, Doctoral Supervisor, Peking Union Medical College Hospital

Women, especially middle-aged and elderly women, sometimes encounter the embarrassment of urinary incontinence. If non-surgical treatments are not effective, then surgical treatment is needed to change the situation.

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1. Three Common Types of Urinary Incontinence Surgery

Urinary incontinence is clinically divided into three main types, namely urge urinary incontinence, stress urinary incontinence and mixed urinary incontinence. The latter two types, namely stress urinary incontinence and mixed urinary incontinence, can be treated surgically.

At present, the commonly used urinary incontinence surgeries in clinical practice are divided into three categories: transvaginal tension-free urethral sling, retropubic bladder and urethral sling, and bladder neck filler injection.

There are two puncture routes for transvaginal tension-free urethral suspension, namely, retropubic puncture and transobturator puncture. The two are suitable for different indications. Retropubic bladder and urethral suspension is to improve the position of the bladder neck and posterior urethra, increase the posterior angle of the bladder and urethra, lengthen the urethra, and enhance urethral resistance to achieve the purpose of treatment.

The injection of bladder neck filler is mainly suitable for stress urinary incontinence caused by internal urethral sphincter disorder. However, the effectiveness of this method decreases year by year, generally only lasting 1 to 2 years, and sometimes another injection is needed.

Risks and complications of anti-incontinence surgery

Surgical treatment may result in surgical risks and complications. The main risks and complications of surgery for urinary incontinence are as follows.

1. Bleeding : The main cause is puncture damage to blood vessels during surgery. After surgery, the hematoma is checked by B-ultrasound, and the bleeding is usually stopped by local compression and the use of hemostatic drugs. If the incision is bleeding, pressure bandage can be applied to stop the bleeding.

2. Bladder and urethra injury : This is mostly caused by the complicated situation in the surgical area and poor control of the puncture needle. The incidence of bladder injury will vary with different surgical methods.

3. Postoperative urination disorder : It is relatively common, and most of the symptoms are mild, manifested as difficulty in urination after surgery. The patient needs to exert force and raise the buttocks to urinate, or it takes multiple times to urinate completely. A small number of patients with more severe symptoms may experience chronic urinary retention and a feeling of incomplete urination.

Urinary disorders are mainly caused by wound infection and edema, but they are mostly transient and can be recovered after about one month of treatment. Symptomatic treatments are usually used, such as antibiotics, antispasmodics, physical therapy, and pelvic electrical stimulation.

4. Wound infection : The main causes of wound infection are bacterial invasion, hematoma, foreign bodies, poor blood supply to local tissues, decreased systemic resistance, etc. Patients experience worsening wound pain 3 to 5 days after surgery, local redness and swelling, tenderness, or fluctuations, and may also be accompanied by elevated body temperature. Wound infection can be prevented by using broad-spectrum antibiotics after surgery.

5. Sling erosion and exposure : The cause may be local infection of the vaginal wall or surgical materials or techniques. Sling erosion and exposure can lead to increased vaginal discharge and discomfort during sexual intercourse. Some patients need another surgery to relieve the discomfort.

6. Leg pain : It often occurs in the groin area and is a unique complication of the obturator-approach vaginal tension-free mid-urethral suspension. The cause of leg pain is the inability to prevent nerve damage during the blind puncture.

7. Others : venous thrombosis, obturator nerve injury, etc., are generally rare.

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3. Preoperative preparation and postoperative precautions for anti-urinary incontinence surgery

1. Preoperative Preparation

(1) A detailed medical history, a full physical examination, and necessary laboratory tests are performed to confirm the diagnosis and exclude surgical contraindications.

(2) Complete routine preoperative preparations according to the doctor's requirements, perform vaginal douching and bowel preparation the night before surgery. Do not eat on the day of surgery. Antibiotics should be used before surgery to prevent infection.

2. Postoperative precautions

(1) Postoperative urination: Patients may experience abnormal urination in the short term after surgery. After the catheter is removed and the patient urinates 3 times, an ultrasound examination is performed to measure residual urine. If the residual urine volume is less than 100 ml, the patient can be discharged from the hospital.

(2) Bleeding: Observe the amount of vaginal bleeding and whether there is bleeding, exudation, hematoma, etc. at the puncture site. Use hemostatic drugs as prescribed by the doctor. Physical therapy can also be used 48 hours after surgery to promote hematoma absorption.

(3) Body temperature: If the patient has a fever of less than 38°C within 24 hours after surgery, it is a normal postoperative reaction and does not require special treatment. If the patient's body temperature suddenly rises 24 hours after surgery and does not drop, the cause of the fever should be identified as soon as possible.

(4) Pain: Generally, postoperative pain is mild and can be treated with oral sedatives and analgesics to improve the patient's comfort. If the patient is in severe pain, the cause must be identified first to avoid delaying the treatment.

(5) Activities: Avoid behaviors that increase abdominal pressure within 3 months after surgery, such as lifting heavy objects, chronic cough, constipation, etc.

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Conclusion

Urinary incontinence does cause a lot of trouble to female patients, and surgical treatment is a feasible solution. Although surgery has risks, as long as the patient cooperates with the doctor's treatment and rests at ease, the trouble of urinary incontinence can be overcome.