Urinary Stress Incontinence / TVT-O sling operation

This topic, I believe, can not be ignored. It is quite a feat for many women, indeed, to make the first step and contact a doctor with the problem. Millions of women suffer from involuntary leakage of urine, which is called urinary incontinence. In some women, it manifests as the form of allocation of a few drops of urine when coughing or laughing. For others, the problem is more pronounced and manifests as urgent, irresistible desire to go to the toilet, and then immediately follows the involuntary release of a large amount of urine.

Many women suffer from both type of symptoms of the disease. Of course, this problem is significantly reduces the quality of life of women. Urinary incontinence may cause a little concern women, and can cause a serious breach of the quality of life of women. The inconvenience and embarrassment deprive the women with urinary incontinence of the joy of spending time with family and friends. Incontinence during sex is also a one of the most intimate problems, which causes a woman very strong emotional stress.

According to European data, about 45% of women aged 40-60 years suffering from varying degrees of incontinence. In Russia, the proportion of women suffering from urinary incontinence is 38.6%. In the West, stress urinary incontinence (urinary incontinence) attach great importance. ICS (International Continence Society), special organization, created and successfully operates. This organization brings together urologists and gynecologists from different countries who are interested in the treatment of urinary incontinence and impaired functioning of the ligamentous apparatus of the small pelvis in women.

Classification

Currently, urinary incontinence can be divided into three forms, which have different causes, the clinical manifestations and, accordingly, the methods of treatment:

  • urgent urinary incontinence, UUI(associated with the urge)
  • stress urinary incontinence, SUI (associated with stress, for example coughing, laughing, etc)
  • mixed.

Why urine is no longer held down?

Urge incontinence. The urine is accumulated in the bladder wall and stretches it. Receptors that are in the bladder wall are excited, and the urge to urinate, that a person can control by squeezing the sphincter of the bladder and pelvic floor muscles, appears. The muscle of the bladder, expelling urine, called the detrusor. Normally, it is relaxed during bladder filling. During the emptying of the bladder, it is contracted, forcing the urine out. Overactive bladder, OAB, is condition when detrusor contracts during the filling of the bladder. In this case urinary incontinence arises if the bladder pressure is greater than the pressure in the urethra. This is disorder of the nervous regulation of the bladder, both the central brain and spinal cord, and peripheral nerve fibers. There is a strong urge to urinate and urine leaks with the sudden urge.

Stress urinary incontinence (SUI) is incontinence when coughing, physical activity, sneezing, laughing, and other activities involving when intra-abdominal pressure increases. The prevalence of stress urinary incontinence is very high. In general, urinary incontinence (all types) suffers at least 30% of the female population, and the incidence is higher in women in old age. True stress incontinence occurs in 50-60% of patients, even in 20-30% of patients mixed form of pathology is found.

Let’s consider the work of the bladder and the urethra in normal conditions. The urine accumulates in the bladder and stays there as long as necessary; the pressure in the urethra must be greater than in the bladder. During exertion, coughing, laughing, etc., the pressure in the abdomen increases. In a normal ligaments condition this pressure is transmitted uniformly to the bladder and urethra. Accordingly, the pressure in the bladder and urethra increases equally. This is so called "transmission of intra-abdominal pressure." If the pelvic ligaments "weaks", the bladder and urethra are shifted down at the time of stress. Consequently, an increase in intra-abdominal pressure is transmitted only to the bladder ;and the urethra pressure moves out of the transmission of intra-abdominal pressure. The pressure in the bladder increases, and in the urethra - no. Hence is the pressure in the urethra less than in the bladder. The result is the loss of urine.

Why ligaments weaken?

The reasons, as we have already written, are different: heavy labor, excessive physical labor, trauma and, of course, the lack of female sex hormones - estrogens. Moreover, estrogen may lack not only during menopause!

 Diagnosis of stress urinary incontinence.

To set the fact of  incontinence is easy. Another, that is often necessary to distinguish exactly the  type of incontinence (urge, stress or mixed).

 How to treat incontinence?

Most women consider it as normal age-related changes or a manifestation of cystitis. Accordingly, these women treat cystitis or are not treated in anyway.

Firstly, it's not cystitis !!!

Second, incontinence is treated !!!

Stress incontinence is treated mainly by surgery correction.

Sling operation, transobturator vaginal tape (TVT, TVT-O) placement is widely practiced in our clinic. TVT-O is method or operation with using free synthetic tape; it is the "gold standard" in treatment of stress urinary incontinence and requires minimal surgical intervention. Postoperative pain is almost absent, and the patient can go home the day after surgery. The result is achieved through the support of the middle of the urethra in the correct position. The operation is usually performed under local or spinal anesthesia. If necessary, general anesthesia are used. Free synthetic loop is a unique innovation; this is a grid of polypropylene coated with a plastic bag, with the needles on the ends. Using the original installation kits and materials manufactured by leading world producers ensures guaranteed quality and prevents complications.

The tape is introduced into the woman's body with the TVT needle through a small incision in the anterior vaginal wall and located under the middle part of the urethra; the tape ensures reliable support, replacing the "weakened" ligament, and thereby eliminating the cause of urinary incontinence. Both needles are ejected through the obturator hole and then removed. The operation lasts 30-40 minutes. The patient can be discharged home the next day.

 

Patients from other cities suggest that treatment at our clinic takes a long period, and therefore it is difficult to come to us! Sometimes this is true, but in most cases a single day is sufficient for the diagnosis. The next day, TVT-operation. To continue treatment patients can at home under our watchful eyes via Skype, email, etc.

Another services