Sling operation for stress incontinence (eg, fascia or synthetic)
CPT4 code
Name of the Procedure:
Sling Operation for Stress Incontinence (e.g., Fascia or Synthetic)
Summary
A sling operation for stress incontinence is a surgical procedure designed to provide support to the urethra using a sling made from either your tissue (fascia) or synthetic material. This helps prevent urine leakage during activities that apply pressure to the bladder, such as coughing or exercising.
Purpose
This procedure addresses stress urinary incontinence, a condition where there is involuntary leakage of urine due to weak pelvic floor muscles or a weakened urethra. The goal is to restore continence or significantly reduce the frequency and amount of urine leakage.
Indications
- Moderate to severe stress urinary incontinence.
- Failure of conservative treatments such as pelvic floor exercises or medications.
- Positive findings on urodynamic tests demonstrating stress incontinence.
- Symptoms include urine leakage during physical activities, coughing, sneezing, or laughing.
Preparation
- Patients may be asked to fast for at least 6-8 hours before the procedure.
- Instructions to stop certain medications like blood thinners.
- Pre-operative tests may include a urine test, urodynamic assessment, and possibly imaging studies.
Procedure Description
- Anesthesia: General or regional anesthesia will be administered.
- Incision: A small incision is usually made in the vaginal wall, with additional smaller incisions in the lower abdomen (for synthetic slings).
- Placement of Sling: The sling, either made from the patient's tissue or synthetic material, will be positioned under the urethra and bladder neck to create a supportive hammock.
- Closing Incisions: The incisions are then closed with sutures.
- Catheter: A temporary catheter might be placed to assist with urination immediately after surgery.
Tools utilized include surgical retractors, suture materials, and, in the case of synthetic slings, specialized sling kits.
Duration
The procedure typically takes about 1 to 1.5 hours.
Setting
The operation is usually performed in a hospital or outpatient surgical center.
Personnel
- Surgeon (usually a urologist or gynecologist)
- Surgical nurse
- Anesthesiologist
- Operating room assistants
Risks and Complications
- Common: Infection, bleeding, difficulty urinating, temporary pain.
- Rare: Sling erosion, urethral injury, bladder perforation, persistent incontinence or urge incontinence.
Benefits
- Reduction or complete cessation of urinary leakage.
- Improved quality of life.
- Benefits are usually noticed within days to weeks post-surgery.
Recovery
- Post-procedure: Monitoring in a recovery room until anesthesia wears off.
- Instructions: Avoid heavy lifting and strenuous activities for 4-6 weeks.
- Most patients can resume regular activities within a few days but should refrain from sexual activity for at least 6 weeks.
- Follow-up appointments will be scheduled to monitor progress and address any concerns.
Alternatives
- Behavioral therapies: Pelvic floor exercises (Kegels).
- Medications: Drugs to enhance urethral sphincter function.
- Other surgical options: Urethral bulking injections, retropubic suspension, or artificial urinary sphincter.
- Pros: Non-surgical options are less invasive but may be less effective for severe cases.
Patient Experience
- During the procedure: The patient will be under anesthesia and should not feel pain.
- Post-surgery: Mild to moderate discomfort managed with pain relievers. A possible urinary catheter for a short period post-op.
- Expect: Some temporary soreness, spotting, or swelling. Full recovery typically occurs within 4 to 6 weeks.