Any surgical intervention requires preparation which may vary depending on each individual. It is essential that you follow the recommendations given to you by your urologist and your anesthesiologist. If these recommendations are not followed, the intervention could be postponed. In view of the intervention, certain examinations may be prescribed (ultrasound, smear, urodynamic assessment, MRI, etc.) An anesthesia consultation must take place a few days before the intervention. You will be asked to perform a urine analysis a few days before the procedure (ECBU). In the event of infection, intervention is deferred until the urine is sterilized.
The procedure is carried out under general anesthesia. It can be performed laparoscopically with or without robotic assistance. In the operating room, you are placed flat on your back. A urinary catheter is placed at the start of the procedure.
The time for removal of the urinary catheter is defined by your surgeon. Resumption of intestinal transit (gas) usually occurs within the first 48 hours. However, constipation can bother you for a few days and continue if you are prone to this problem. You may then be prescribed a laxative treatment. The length of hospitalization is usually a few days. A convalescence is expected. Its duration is adapted to the work you do. You should refrain from exercise, sports, carrying heavy loads, taking baths and having penetrative sex for approximately 1 month.
A follow-up consultation with your urologist is planned a few weeks after the procedure. This decides on the possibility of resuming all your activities, particularly sporting activities. You must avoid violent efforts in the 3 months following the procedure. Sexuality By replacing the descended organs in the correct position, the intervention most often allows you to improve your sexuality.
On the other hand, the quality of intercourse can rarely be altered by pain and vaginal lubrication problems. You may be prescribed treatment to improve these local phenomena.
Healing Laparoscopic surgery involves one or more incisions of varying size. These incisions are not only areas of weakness, but also possible entry points for infection. It is therefore necessary to ensure good local hygiene. If the scar becomes red, hot or if it is raised, it is important to show this scar to your surgeon without urgency: it may be a hematoma or an abscess. The skin heals over several days. During this period, a little bleeding may occur which can be stopped by compressing it with a compress or a clean cloth.
The removal of the wires or staples is carried out by a nurse at home following the medical discharge prescription. Disunion of the skin can sometimes occur. If this opening is superficial, you simply have to wait for it to close; the closing time can reach several weeks (especially in diabetic patients or those on corticosteroid treatment). On the other hand, in the event of a feeling of deep cracking or deep disunity, it is necessary to consult your surgeon quickly.
You will be able to resume normal activity but violent efforts and carrying heavy loads (greater than 5 kg) are prohibited for 3 months. Your usual sporting activities will need to be interrupted for 1 to 3 months depending on the type of sport and its intensity. Cycling and motorcycling is also not recommended for 1 month. You must absolutely avoid constipation so as not to have to strain to have a bowel movement. Transit-facilitating treatment is often necessary for several weeks. You will need to avoid baths, penetrative sex and periodic tampons for six weeks following the procedure. When showering, you can wash the skin incisions with your usual soap. Be sure to dry them by dabbing or hairdrying to avoid any maceration. Tobacco and malnutrition slow down healing. Post-operative fever The occurrence of a fever after the treatment of genital prolapse
Clinically, the patient describes involuntary urine leaks occurring during exercise: coughing, sneezing, carrying a load, playing sports, etc. The doctor’s questioning looks for risk factors, assesses the frequency of leaks, and the quantity of urine lost (severity of incontinence).
The clinical examination, carried out with a full bladder, is sufficient to confirm the diagnosis. The doctor performs a cough test, trying to visualize a jet leak through the urinary meatus during coughing (in a lying and standing position). It also assesses the mobility of the urethral canal. The urogynecological examination looks for a disorder of vaginal trophicity, and eliminates an associated genitourinary prolapse.
Treatment depends on the discomfort caused by this incontinence: only patients who are embarrassed and request treatment are treated. Therapeutic possibilities are:
Perineal rehabilitation: in a bothered patient, perineal rehabilitation may be offered as a first-line procedure, with the need to carry out several sessions. There is a risk of secondary failure even if there is immediate improvement.
Lifestyle measures: treat associated constipation, cough, vaginal dryness. Furthermore, weight loss in obese patients is associated with a reduction in incontinence symptoms.
Surgical treatment: this is the alternative to rehabilitation, in the event of failure, contraindication or refusal by the patient. Before confirming the surgery, a more in-depth clinical examination is carried out, including evaluation of the urethral support maneuvers. An assessment of urination using a urine flow meter is also necessary to verify proper bladder emptying before any surgery. Depending on this clinical evaluation, a urodynamic examination (see specific sheet) may be carried out.
The possible surgical solutions are (see specific sheets):
The indication for these different treatments depends on the medical and surgical history, the type of incontinence mechanism, the severity of the disorders, and above all the results of the clinical evaluation and any additional examinations.
As explained above, urge urinary incontinence is characterized by leaks occurring immediately after an urge (sudden, brutal and irrepressible urge to urinate). The symptom of urgency characterizes overactive bladder. Most often, it is accompanied by other symptoms: pollakiuria (excessive urinary frequency) and nocturia (nocturnal awakenings by the need to urinate).
The questioning first seeks to clearly identify the emergency symptom and to identify the history (in particular of smoking, which may indicate a risk of bladder tumor), the associated pathologies, the interventions on the pelvis, the medical treatments taken. by the patient.
The urogynecological examination looks for a disorder of vaginal trophicity, and eliminates an associated genitourinary prolapse. The examination verifies the absence of suburethral support defects and urinary leakage when coughing.
A neurological examination is also performed.
A voiding calendar (consisting of noting the times of urination as well as their volume) is necessary to assess voiding frequency, symptoms, the presence of nocturia and overall diuresis. The impact on daily life is also evaluated.
The quality of bladder emptying is assessed by the flow meter.
Additional examinations are sometimes necessary to look for irritating factors (bladder tumor, foreign body, intravesical stones) by cytobacteriological analysis of urine, ultrasound, cystoscopy and urinary cytology. A urodynamic examination may be offered, most often before invasive treatment.
If a cause is identified (bladder injury for example), it must be treated.
Otherwise, treatment will be symptomatic with first-line hygiene and diet measures, rehabilitation or drug treatment:
▪ Hygieno-dietary measures: in certain cases, the patient will need to be advised to adapt her diet and lifestyle. Smoking should be stopped. Certain products (beer).
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