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COLPOSUSPENSION

Colposuspension is an operation which involves the placement of permanent stitches at the level of the bladder neck, which serve to lift up the bladder neck and correct the problem of stress incontinence. Until around ten years ago, colposuspension was the major operation performed for women with stress incontinence, and we have much long term data on its safety and effectiveness. It has now been superceded by the mid-urethral tape procedure (“retropubic” and “trans-obturator”) for the surgical treatment of stress incontinence, although it remains a treatment choice for some women. We are able to perform this operation through keyhole surgery (“laparoscopic colposuspension”), which offers the advantages of less scarring and a quicker recovery, than when the operation is performed through a larger abdominal incision. We would tend to choose this operation for particularly young women, or for women who are already having surgery for significant associated prolapse of particular vaginal muscles.

 

What happens after the operation?


After the operation, you may experience nausea and wound pain. Medication will be given to relieve these symptoms. You will normally be allowed to drink and eat on the same day of operation.  Some women will have a small drain (a fine tube which stops fluid and blood collecting inside your pelvis by draining it to the outside) which is normally removed the following day. The urinary catheter will be removed usually after three days. Some women will already have gone home and may return to have the catheter removed.  The nurse looking after you will make sure you are passing water without a problem and check there is not a large volume of urine left in the bladder after you have finished urinating.  A small number of women will inadequately empty their bladders. They will go home with a catheter in and come back a week later for removal of the catheter. If a vaginal pack / bandage is used at the time of surgery, it is removed the following day.


You are likely to experience pain in the abdomen / pelvis that will require regular painkillers for a few weeks following surgery.


Are there any risks?


Laparoscopic colposuspension is very safe and effective, but as with any surgical procedure there are risks attached. The risks common to all operations include anaesthetic risks, infection, bleeding, recurrence of symptoms  and formation of a blood clot in the legs/lungs. The main risks specific to laparoscopic colposuspension are:

 

Damage to surrounding structures: This includes bowel, or ureters (pipes leading from the kidneys to the bladder). The risk of this is extremely small (less than 1%) although may be higher if you have had previous abdominal / pelvic operations. There is a risk of damage to the bladder, although we put a small camera inside the bladder during the procedure to check for this. If the bladder were to be inadvertently cut it can be repaired at the time of surgery. If stitches are inadvertently put into the bladder, they can be removed, and the operation can normally still be completed. The bladder generally heals very well with no lasting adverse effects, although a catheter may need to rest the bladder for around ten days following surgery.

 

Urinary Retention: (Difficulty or failure to pass urine) This is quite common as a temporary problem and means that your catheter may need to stay in place for a couple of weeks. In a very small number of women, (1-5%), the bladder continues to not empty adequately, and women may need to learn to self-catheterise. This latter process involves passing a very fine straw size catheter into the bladder on a daily basis. To reiterate this outcome is uncommon, but every woman needs to be aware of this.

 

Urgency: Some women have an element of urgency (needing to rush to the toilet) prior to the operation. For them, this symptom may get marginally better or worse. Occasionally for other women, there may be new symptoms of urgency. This generally only lasts a few months and can be treated with tablets.

 

The need for a laparotomy (wider cut in the abdomen): This is a risk for anyone undergoing a laparoscopy, and occurs if there is significant bleeding or damage to surrounding structures, and is very unlikely (less than 2%)


What should I do after the operation?


You should be back on your feet quite quickly, but you avoid heavy lifting for 6 weeks. There may be some bleeding / brown vaginal discharge as the wounds in the vagina heal which is completely normal.

 

Sexual intercourse may be resumed after 4 weeks if you are feeling comfortable and the discharge has stopped. We generally suggest at least 4 weeks off work.


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