Families Unit Division Sub-Urethral Tape Procedure Operations Patient Information Leaflet Options available If you d like a large print, audio, Braille or a translated version of this leaflet then please call: 01253 955588 People Centred Positive Our Four Values: Compassion Excellence
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After your surgery You will be given a dose of antibiotics in theatre and a 5 day course of antibiotics to go home with. During the first 24 hours after your surgery you may feel more sleepy than usual and your judgement may be impaired, therefore during this time you should not drive or make any important decisions. The stitches in your vagina and lower abdomen or thighs will not need to be removed as they are dissolvable. They will dissolve within a few weeks and you may note some vaginal discharge which is normal. You will be discharged on the day of your surgery once the nursing staff are happy that you are emptying your bladder, the vaginal bleeding is not too heavy and any discomfort is under control. Bring your own sanitary towels to deal the light bleeding experienced. You will have been taught how to empty your bladder by ISC prior to surgery. This technique will be needed if you have difficulty emptying your bladder after surgery due to swelling and bruising. This will be needed for a few days up to a maximum of 6 weeks. If you have difficulty emptying your bladder after surgery you may need to have an indwelling catheter. Washing and showering can take place after surgery as normal. Page 4
Pelvic floor muscle training Once you return home you can restart you pelvic floor muscle training (do not perform these if you have a catheter in): Squeeze and lift your pelvic floor muscles from the back passage (anus) towards the front passages (vagina and urethra) as well as you can for up to 10 seconds for 10 times in lying or sitting positions, 3 times a day Also it is important to squeeze and lift your pelvic floor muscles before and during activities that increase abdominal pressure i.e. coughing, sneezing and lifting. This is known as the 'Knack' manoeuvre. Recovery It is important to avoid straining particularly in the first 2-3 weeks after surgery. Therefore, avoid constipation and heavy lifting. Maintain your level of fitness when you return home by taking short walks, building up slowly as you feel able. Driving, work and other activities: You should be able to drive and be fit enough for your usual activities within 2-3 weeks of your surgery. You could return to your job within 2-3 weeks as long as there is no heavy lifting involved or you can do lighter duties. You should allow 6 weeks to return to a manual job and also when returning to sport for example swimming. Intercourse: Allow 6 weeks before returning to intercourse. Page 5
Success of the procedures The success rate of the TVT and TOT procedures differ from hospital to hospital. Currently we have a 85-90% success rate, the national average being 90%. The tape procedures are permanent. You should note a recovery from your stress urinary leakage following the surgery but this can take time during the healing process. If you note leakage intially this should settle. If it does not please seek advice from your GP as it could easily be caused by an infection or possibly the bladder being irritable, which can be treated. Risks of the procedures Risks of the procedures will be discussed with you in detail when you are listed for the procedure, either TVT or TOT. General Risks: Bleeding - due to a cut being made in the front vaginal wall Infection - this will be covered by a dose of antibiotics in theatre and a course when you are discharged Specific Risks: Damage to bladder - this is very rare and if happens it will be dealt with during the surgery, following which an indwelling catheter will be needed for a period of time. Urinary retention - this can occur in 1 in 20 women having either a TVT or TOT and is due to swelling and bruising. This is dealt with either by you using the ISC taught prior to the procedure; usually needed for a few days up to a maximum of 6 weeks, or an indwelling catheter could be used for a period of time. Bladder overactivity - any operation around the bladder has the potential for making the bladder overactive leading to symptoms such as urgency (needing to rush to the toilet) and frequency (needing to visit the toilet more often than normal). This can occur in 1 on 10 women. This can be asssessed by your GP and treated as needed. Page 6
When should I seek medical advice after a sub-urethral tape procedure? It is not the policy of the hospital to see you after your surgery. However, you should seek the advice from your GP if you experience any of the following: Burning and stinging when you pass urine - take a urine sample to your GP as you may have a urinary tract infection. Heavy or smelly vaginal bleeding or bleeding which starts again - see your GP as you may have a wound infection. Sharp pain experienced by you or your partner during intercourse - this needs to be assessed by your GP. Difficulty passing urine and emptying your bladder - as stated previously if you have been taught intermittent self catheterisation techinique, this can help. If you need further assistance you may contact our Nurse Practitioner. You may also require an indwelling catheter (a catheter that stays in) for a period of time to assit this problem. You may note that your urine flow alters following the surgery. As long as you are not in difficulty emptying your bladder, a change of flow or the need for you to sit forwards or even stand to pass urine may be acceptable following these procedures. Page 7
Useful contact details Lavinia Parkinson Gynaecology Nurse Practitioner Bleep 125 Hospital Switchboard: 01253 300000 Patient Relations Department The Patient Relations Department offer impartial advice and deal with any concerns or complaints the Trust receives. You can contact them via: Tel: 01253 955589 email: patient.relations@bfwh.nhs.uk You can also write to us at: Patient Relations Department, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NR Further information is available on our website: www.bfwh.nhs.uk References This leaflet is evidence based wherever the appropriate evidence is available, and represents an accumulation of expert opinion and professional interpretation. Details of the references used in writing this leaflet are available on request from: Procedural Document and Leaflet Coordinator 01253 953397 Approved by: Clinical Improvement Committee Date of Publication: 24/04/2013 Reference No: lc00010192 - PL/819 v1 Author: Joanne Massey Review Date: 01/04/2016