51845 Abdomino-vaginal vesical neck suspension, with or without endoscopic control (eg, Stamey, Raz, modified Pereyra)

Name of the Procedure:

Abdomino-vaginal Vesical Neck Suspension (e.g., Stamey, Raz, modified Pereyra)

Summary

This procedure involves lifting and supporting the neck of the bladder to prevent urinary incontinence. Surgeons use abdominal and vaginal approaches, sometimes guided by endoscopic visual control, to place sutures or slings that hold the bladder neck in the correct position.

Purpose

Abdomino-vaginal vesical neck suspension is used to treat urinary incontinence, specifically stress urinary incontinence, caused by weakened pelvic muscles and tissues. The goal is to restore normal bladder function and prevent unintentional urine leakage.

Indications

• Stress urinary incontinence
• Leakage of urine during physical activities, such as coughing, sneezing, or exercise
• Patients for whom less invasive treatments (e.g., physiotherapy, medications) have not been effective
• Women with a diagnosis confirmed by urodynamic testing

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications, especially blood thinners, might need to be adjusted.
• Pre-operative assessments may include urodynamic tests, physical exams, and imaging studies.

Procedure Description

1. The patient is typically placed under general anesthesia.
2. Surgeons make a small incision in the lower abdomen and possibly another in the vaginal wall.
3. Using both abdominal and vaginal approaches, sutures or a sling are placed around the bladder neck.
4. Sutures are anchored to supportive tissues or ligaments to lift and stabilize the bladder neck.
5. The use of an endoscope may assist in visualizing the area and ensuring precise placement.
6. Incisions are closed, and the patient is taken to recovery.

Duration

The procedure generally takes between 1 to 2 hours.

Setting

This surgery is usually performed in a hospital or a specialized surgical center.

Personnel

• A General Surgeon or Urologist
• Surgical nurses
• Anesthesiologist
• Endoscopic specialists (if endoscopic control is used)
• Operating room assistants

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding organs or tissues
• Recurrence of incontinence
• Difficulty urinating post-procedure, requiring temporary catheterization

Benefits

The primary benefit is improved control over urination, reducing or eliminating leakage. Most patients experience significant symptom relief shortly after recovery.

Recovery

• Patients may need to stay in the hospital for a day or two.
• Pain and discomfort managed with prescribed medications.
• Avoid heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor healing and effectiveness.
• Most patients return to normal activities within 4 to 6 weeks.

Alternatives

• Pelvic floor exercises (e.g., Kegels)
• Behavioral therapies and lifestyle modifications
• Medications targeting urinary incontinence
• Minimally invasive procedures like urethral bulking agents or bladder injections
• More extensive surgical options if needed

Patient Experience

Patients might experience some discomfort and limited mobility immediately after the procedure. There may be mild to moderate pain, swelling, and bruising. Pain management includes prescribed painkillers and non-steroidal anti-inflammatory drugs (NSAIDs). Most patients report a significant improvement in symptoms and quality of life after recovery.