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Sling Operation During Vaginal Prolapse Surgery Reduces Post-operative Urinary Incontinence

by Dr. Simi Paknikar on  July 18, 2012 at 2:20 PM Health In Focus   - G J E 4
A sling operation performed during vaginal prolapse surgery reduces the chances of post-operative urinary incontinence; however, it is associated with serious adverse effects.
Sling Operation During Vaginal Prolapse Surgery Reduces Post-operative Urinary Incontinence

Prolapse is a condition where an organ falls out of its original location in the body. It commonly affects women in whom organs like the uterus, bladder, or the vaginal wall move downwards through the vagina or the rectum. People who suffer from prolapse undergo an operation to replace the organ into the normal position. However, one complication of such an operation is loss of urine retaining ability thereby resulting in urinary incontinence, which could affect the social life of the individual.

Researchers carried out a study to evaluate if an additional surgery to add support to the urethra could reduce the chances of urinary incontinence following prolapse surgery. The study included women who did not suffer from prior urinary incontinence and were due to undergo vaginal prolapse surgery.

Some of the women in the study received a retropubic midurethral sling during the operation to repair the vaginal prolapse. A sling operation is a procedure where a sling is placed under the urethra to support it and prevent urinary incontinence in conditions of increased intra-abdominal pressure like while laughing, sneezing or during physical activity. The women were assessed at 3, 6 and 12 months following the surgery. A total of 337 women completed the follow-up at 1 year.

Three months following surgery, the incidence of urinary incontinence was nearly half in the group that received the sling operation as compared to those who did not receive the urethral support (23.6% vs 49.4%). This benefit persisted even twelve months following the operation (27.3% vs. 43.0%).

However, the rate of complications was significantly more in the group that underwent the sling operation and included bladder perforation (6.7% vs. 0%), urinary tract infection (31.0% vs. 18.3%), bleeding complications (3.1% vs. 0%), and incomplete bladder emptying (3.7% vs. 0%) in the first 6 weeks after surgery.

The study thus reiterates the advantages of urethral support operations during vaginal prolapse surgery. However, the benefits of the surgery must be weighed against the possibility of serious adverse effects, and the decision should be individualized for each patient.

Reference:

1. A Midurethral Sling to Reduce Incontinence after Vaginal Prolapse Repair; John T Wei et al; N Engl J Med 2012; 366:2358-2367

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This is a report based ONLY on one study and does not at all give the realistic figures. A lot depends on the surgeon also who is doing the operation. Yes there is a higher chance of bladder perforation upto 3% and this is looking at the worldwide data in general. But the bladders heal quite well as long as the injury is away from the ureters. The success reported is usually 85-95% on an average with the retropubic sling. Correct patient selection and informing patients of the complications beforehand and explaining to them the recovery is extremely important. It is an operation which a woman might chose for improved lifestyle as opposed to leaking all the time and wearing pads.If you look at the effect of incontinence on women it is quite severe. However, any similar surgery should be patient choice and an informed decision where the patient understands the risks and decides for herself.
bhanu75 Thursday, August 23, 2012

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