Name of the Procedure:

Plastic Operation on Urethral Sphincter, Vaginal Approach (Kelly Urethral Plication)

Summary

A plastic operation on the urethral sphincter using a vaginal approach, also known as Kelly urethral plication, is a surgical procedure designed to support and tighten the urethral sphincter. This helps control urine leakage and treat conditions related to urinary incontinence.

Purpose

The medical condition it addresses is stress urinary incontinence, where a slight increase in abdominal pressure (such as when coughing or sneezing) causes unintentional urine leakage. The goal of this procedure is to strengthen the area around the urethra, improving bladder control and reducing or eliminating urinary incontinence.

Indications

Patients experiencing symptoms of stress urinary incontinence, such as:

• Urine leakage during physical activities.
• Increased urinary frequency or urgency. This procedure is appropriate for those who have not found relief from conservative treatments like pelvic floor exercises or medications.

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Medication adjustments may be needed (e.g., stopping blood thinners).
• Pre-procedure diagnostic tests like urodynamic studies or a physical examination will be conducted to assess the severity of incontinence.

Procedure Description

1. The patient is placed under regional or general anesthesia.
2. A small incision is made in the vaginal wall to access the urethral sphincter.
3. Sutures are placed to plicate or tighten the tissue around the urethra, providing better support and control.
4. The incision is closed with absorbable sutures. Tools/Equipment: Surgical sutures, needles, and standard surgical instruments. Anesthesia: General or regional anesthesia is used to ensure patient comfort.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

The procedure is performed in a hospital or a specialized surgical center.

Personnel

• Urologist or gynecologic surgeon
• Anesthesiologist
• Surgical nurses and assistants

Risks and Complications

Common risks include:

• Infection
• Bleeding Rare complications may include:
• Injury to surrounding organs
• Persistent incontinence
• Urinary retention Management of complications includes antibiotics for infection and additional interventions for other complications as needed.

Benefits

Improvement in bladder control and significant reduction or cessation of urinary incontinence. Benefits can often be realized shortly after recovery, although full effects may take several weeks.

Recovery

• Post-procedure care includes avoiding heavy lifting and strenuous activities.
• Pain management with prescribed medications.
• A follow-up appointment within a few weeks to monitor healing.
• Recovery time typically spans from 2 to 4 weeks, with most patients returning to normal activities within a month.

Alternatives

• Pelvic floor physical therapy (Kegel exercises)
• Medications to control incontinence
• Other surgical options like sling procedures Pelvic floor exercises are less invasive but may be less effective in severe cases. Medications may offer temporary relief, while other surgical options might have different risk profiles.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-operatively, there may be discomfort, managed through pain medications. Full recovery includes gradual resumption of daily activities and adherence to post-surgical care instructions.