Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic)
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; sling operation for stress incontinence
Common names: Sling procedure, Laparoscopic sling, Stress incontinence surgery
Technical terms: Laparoscopic colposuspension, Sling cystourethropexy
Summary
Laparoscopy for sling operation is a minimally invasive surgical procedure designed to treat stress urinary incontinence (SUI). During the procedure, a sling is placed around the urethra to provide additional support that helps prevent urine leakage during activities that put pressure on the bladder, such as coughing, sneezing, and lifting.
Purpose
Medical condition: Stress urinary incontinence (SUI)
Goals: To provide support to the urethra and bladder neck, reducing or eliminating urine leakage due to stress on the bladder.
Indications
Symptoms: Urine leakage during physical activities like coughing, sneezing, laughing, or exercise
Criteria: Diagnosis of SUI, failure of conservative treatments such as pelvic floor exercises or medication, healthy enough for surgery, no active urinary tract infection
Preparation
Instructions: May include fasting for 8 hours before the procedure, stopping certain medications as advised by the doctor
Tests: Preoperative evaluations like urinalysis, urodynamic studies, and pelvic ultrasound might be required
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incisions: Small incisions are made in the lower abdomen to insert a laparoscope (a thin, lighted tube with a camera).
- Placement: Using specialized instruments, the surgeon places a sling made of synthetic material or the patient’s own tissue around the urethra and attaches it to the pelvic tissue.
- Closure: The incisions are then closed with sutures or surgical glue.
Tools and technology: Laparoscope, surgical mesh or fascial sling, laparoscopic instruments
Duration
Approximately 1 to 2 hours.
Setting
Performed in a hospital or surgical center equipped with the necessary technology for laparoscopic surgery.
Personnel
The procedure involves a surgical team including a surgeon specializing in urology or gynecology, anesthesiologist, and operating room nurses.
Risks and Complications
Common risks: Infection, bleeding, pain at the incision site
Rare risks: Injury to surrounding organs like the bladder or bowel, persistent incontinence, urinary retention, erosion of the sling material, need for repeat surgery
Benefits
Expected benefits: Significant reduction or elimination of urinary leakage during physical activities.
Realization time: Benefits are often noticeable within a few weeks following surgery, with full recovery typically achieved within a few months.
Recovery
Post-procedure care: May include pain management, avoiding strenuous activities for several weeks, and maintaining good hygiene at the incision site.
Recovery time: Most patients resume normal activities in 2 to 6 weeks. Follow-up appointments are necessary to monitor healing and the success of the procedure.
Alternatives
Non-surgical: Behavioral therapies, pelvic floor exercises (Kegel exercises), medications
Other surgical: Burch colposuspension, bulking agents
Pros and cons: Non-surgical treatments are less invasive but might be less effective. Alternative surgeries carry their own sets of risks and may differ in efficacy.
Patient Experience
During the procedure: The patient will be under general anesthesia and will not feel anything.
After the procedure: Some pain and discomfort are common at the incision sites; pain management will be provided. Gradual improvement in symptoms can be expected, with follow-up appointments to ensure proper recovery.