Vaginal Tapes to Treat Stress Incontinence. Patient Information

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1 Vaginal Tapes to Treat Stress Incontinence Patient Information Author ID: JD Leaflet Number: Gyn 044 Version: 6 Name of Leaflet: Vaginal Tapes to Treat Stress Incontinence Date Produced: May 2017 Review Date: May 2019

2 What is stress urinary incontinence? The muscles and ligaments of the pelvic floor support the bladder and help keep it closed or open as necessary. Stress urinary incontinence (usually referred to simply as stress incontinence) happens when these supporting tissues become weak, so when there is sudden extra pressure stress on your bladder, it cannot stay closed as it should and some urine leaks out. This leakage can happen during normal everyday activities, and in particular when you cough, sneeze, laugh, exercise or change position. Whether you leak a small or large amount of urine, stress incontinence can be embarrassing and distressing. Stress incontinence can be triggered by pregnancy, childbirth, weight gain or the menopause but sometimes there is no clear cause for it. Do I need treatment? What you do about stress incontinence will depend on how far it affects you and what you feel you can cope with as well as your general health. What treatments are available? Practical advice from a continence nurse specialist On managing your daily life such as: adjusting your daily routines to help you cope better how you can help yourself by losing weight if you are overweight managing a chronic cough if you have one giving up smoking. Physiotherapy Special physiotherapy exercises can make your pelvic floor muscles stronger and improve control of your bladder. These carry up to 70% chance of improving or curing symptoms. It is usually recommended that a programme of physiotherapy be undertaken prior to considering any surgery. Tablets A tablet called Duloxetine (Yentreve) can help stress incontinence for some people, though it only works whilst you are taking it and does not suit everyone. Outpatient procedure Stress incontinence can be treated by an outpatient procedure avoiding the need for admission. Complications are rare but success rates are slightly lower than for surgery. Bulkamid (urethral bulking agent) described in a separate leaflet Surgery Not everyone with stress incontinence needs an operation. Whether you choose to have surgery will depend on how far stress incontinence affects your daily life and what you feel Vaginal Tapes to Treat Stress Incontinence Page 2 of 7

3 you can cope with. You may want to consider surgical options if other things (such as exercises to help strengthen the muscles in the pelvic floor) have not helped. Surgical procedures for stress incontinence are not usually recommended if you still plan to have children, or think you might want to in the future. Before any surgical procedure you will be asked to attend for tests on your bladder (urodynamic studies) to confirm that the problem is stress incontinence and therefore likely to be helped by surgery. Surgical options available in Wigan and Leigh are: Vaginal tapes (TVT or TVT-O) Colposuspension Vaginal tapes A vaginal tape procedure is a fairly minor operation, which treats stress incontinence (leaking urine with coughing, sneezing and exertion). It was developed in Sweden and has been used there in its current form since Some years later further developments meant that other similar techniques became available using the same (or a very similar) tape but different needles. The traditional retropubic TVT is inserted through a small cut within the vagina and brought out behind the pubic bone through 2 small cuts just below the bikini line. The newer trans-obturator techniques also use a similar cut in the vagina but pass out of the pelvis through a natural gap in the pelvic bones called the obturator foramen and are brought out through a small cut on the inner thigh on each side. These procedures are described in a leaflet produced for use throughout the UK. Synthetic Vaginal Mesh Tape Procedure for the Surgical Treatment of Stress Urinary Incontinence in Women You will be given a copy of this leaflet and asked to complete the information checklist at the end of it before you have your operation. In Wigan we offer GYNECARE TVT Retropubic System for Incontinence Ethicon (TVT) GYNECARE TVT Obturator System for Incontinence Ethicon HCP (TVT-O) We have carried out TVT procedures since 1998 and TVT-O procedures since All proposed vaginal tape operations are discussed in a multidisciplinary team meeting before the proposed date for the surgery. Vaginal Tapes to Treat Stress Incontinence Page 3 of 7

4 After the operation in Wigan and Leigh You will not have a catheter after the operation unless a needle has passed into your bladder during the operation, in which case you will have a catheter immediately after the operation but this is usually removed once it is certain that there is no bleeding into the bladder. Vaginal gauze packs are not routinely used You may experience discomfort in your tummy for the TVT and in your upper legs (similar to period pain) for the TVT-O. This is usually relieved by mild pain killing tablets. Most people go home on the same day as the operation. Occasionally if there is any difficulty passing urine a catheter is placed in the bladder for a few days to allow any swelling to settle and improve urine flow. If this is needed you will be given full instructions for managing this and an appointment will be arranged for you to attend to have the catheter removed. Any stitches will dissolve. You may notice a few pieces of stitch falling out of your vagina after a week or so as the vaginal stitch gradually dissolves. If you work you will require between 2 and 4 weeks off work. You should avoid any straining which causes discomfort but otherwise no special precautions are required. You can drive as soon as you can do an emergency stop without pain. Bathing and showering is as usual. Avoid intercourse for about 6 weeks to allow the vagina to heal as this reduces the risk of the tape becoming exposed in the vagina. Follow up You will be seen in clinic after 8-12 weeks or sooner if you are having any problems. Success rates in Wigan and Leigh These procedures are designed to cure stress incontinence (leaking with coughing, sneezing, exercise). Published studies indicate success rates between 65% and 85% from these procedures. Vaginal Tapes to Treat Stress Incontinence Page 4 of 7

5 In Wigan a questionnaire to all ladies who have had the operation indicated that with regard to stress incontinence after a year 70% (70 out of 100) of ladies have none 11% (11 out of 100) leak only very occasionally and do not require pads 4% (4 out of 100) are no better 15% (15 out of 100) did not reply. There is also sometimes an improvement in associated urgency (a need to reach a toilet urgently) 50% (50 out of 100) are improved 40% (40 out of 100) are no different 10% (10 out of 100) are worse The procedure is never successful for those with urgency but no stress incontinence. We carried out a survey after 10 years of the ladies who had been pleased with the operation initially. 76% were still very pleased and 16% were fairly pleased, with only 8% expressing dissatisfaction. 84% reported a big improvement in their quality of life. Choosing between a TVT and a TVT-O This can be a difficult decision to make since there are only slight differences between the two types of procedure. The TVT has been used for longer and although the TVT-O seems just as successful in the short term there are few long term figures available yet. The TVT on the other hand has been shown to still be effective in most ladies at least 10 years later. A general anaesthetic is needed for a TVT-O so if you wish to avoid this you should choose a TVT. You need to be able to bend your hips up fully without any discomfort in your hips or your back to have a TVT-O but a TVT can be done without bending your hips so far. The tightness of the tape is tested during the operation if you are awake but this is not possible if you are asleep. However, this does not seem to affect the overall success rate of the operation. The TVT-O needles do not pass around your bladder so you do not routinely require a cystoscopy (camera examination of the bladder) as there is only a very low risk of the needle passing into the bladder. On the other hand although this is described as a risk for TVT, in Wigan it has only occurred very occasionally. It can also occur with TVT-O, especially if you have had previous surgery around the bladder. Vaginal Tapes to Treat Stress Incontinence Page 5 of 7

6 The TVT-O procedure is quicker to perform so if you are having a general anaesthetic or if it is combined with another operation there may be a benefit to having a TVT-O rather than a TVT. Vaginal Tapes to Treat Stress Incontinence Page 6 of 7

7 Comments, Compliments or Complaints The Patient Relations/Patient Advice and Liaison Service (PALS) Department provides confidential on the spot advice, information and support to patients, relatives, friends and carers. Contact Us Tel: (Monday to Friday 9am to 4pm) The Patient Relations/PALS Manager Wrightington, Wigan and Leigh NHS Foundation Trust Royal Albert Edward Infirmary Wigan Lane Wigan WN1 2NN Ask 3 Questions Become more involved in decisions about your healthcare. You may be asked to make choices about your treatment. To begin with, try to make sure you get the answers to three key questions: 1. What are my options? 2. What are the pros and cons of each option for me? 3. How do I get support to help me make a decision that is right for me? How We Use Your Personal Information For details on how we collect, use and store the information we hold about you, please take a look at our how we use your personal information leaflet which can be found on the Trust website: This leaflet is also available in audio, large print, Braille and other languages upon request. For more information call Wrightington, Wigan and Leigh NHS Foundation Trust All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright owner Vaginal Tapes to Treat Stress Incontinence Page 7 of 7

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