Name of the Procedure:

Repair Device, Urinary, Incontinence, with Sling Graft (C1771)

Common name(s): Urinary sling procedure, Sling surgery for incontinence
Technical/Medical terms: Synthetic sling placement, Midurethal sling surgery for stress urinary incontinence (SUI)

Summary

The urinary sling procedure is a surgical technique to treat urinary incontinence. It involves placing a small, supportive sling around the urethra to lift it back into its normal position. This helps prevent unintentional urine leakage during activities like coughing, sneezing, or exercising.

Purpose

This procedure addresses stress urinary incontinence (SUI), which is the unintentional leakage of urine during physical activity or exertion. The primary goal is to provide long-term relief from symptoms and improve quality of life.

Indications

• Persistent stress urinary incontinence that has not responded to non-surgical treatments
• Severe SUI causing significant impact on daily activities
• Patients in good health overall, able to tolerate surgery

Preparation

• Patients may need to fast for 8 hours before the procedure.
• Adjust or stop certain medications as directed by the physician.
• Pre-procedure diagnostic tests may include urodynamic studies, urine tests, and imaging of the bladder and urethra.

Procedure Description

1. Anesthesia is administered: general or spinal.
2. A small incision is made in the vaginal wall or lower abdomen.
3. A synthetic sling made of mesh material is positioned beneath the urethra.
4. The sling is secured to pelvic tissues or muscles.
5. The incisions are stitched closed, and a catheter may be placed temporarily to drain the bladder.

Tools: Synthetic mesh sling, surgical instruments, catheter

Anesthesia: General or spinal anesthesia

Duration

The procedure usually takes about 1 to 1.5 hours.

Setting

Typically performed in a hospital or a specialized surgical center.

Personnel

• Surgeon specialized in urology or gynecology
• Anesthesiologist
• Surgical nurses and technicians

Risks and Complications

• Common: Temporary difficulty urinating, pain at the incision site, urinary tract infections (UTIs)
• Rare: Injury to the bladder or urethra, mesh erosion or rejection, chronic pain, pelvic organ prolapse

Benefits

• Significant reduction or elimination of urinary incontinence.
• Improvements in quality of life and daily activities.
• Benefits may be realized within a few weeks after surgery.

Recovery

• Post-procedure: Patients may experience some pain and discomfort, managed with medications.
• Avoid heavy lifting, strenuous activities, and sexual intercourse for 4-6 weeks.
• Follow-up appointments to check healing and sling function.
• Most patients can return to normal activities within a few weeks.

Alternatives

• Pelvic floor exercises (Kegels)
• Medications
• Pessary devices
• Other surgical options like urethral bulking agents or colposuspension Pros and cons should be discussed with a healthcare provider to determine the best treatment for the individual.

Patient Experience

• During the procedure: Patients will be under anesthesia and should not feel pain.
• After the procedure: Some discomfort and pain are expected, manageable with prescribed pain relief.
• Urine catheterization may be uncomfortable but usually removed within 24 hours.
• Encouraged to rest and follow post-operative care instructions to ensure proper healing.