Burch Para-Urethral Repair
Product Summary: AMA rates
Intrapelvic open procedure for the repair of the pelvic floor
Item Number: 37044, 36812, 18262, 105
Why is it done?
- Stress incontinence
- A combination of stress incontinence and detrussor overactivity
- Involuntary urine leakage with any exertion, coughing or sneezing
- Risk factors
- More than 2 pregnancies, big babies.
- complicated deliveries, episiotomy.
- Being overweight.
- Where Intrinsic Sphincter Deficiency has been proved due to a failed previous sling.
- Failed previous incontinence procedures.
- An informed consent is required from the patient and a pre-admission clinic will be arranged.
- Patients may not eat or drink from midnight the previous evening.
- Patients are to refrain from smoking before the procedure.
- Patients allergic to IODINE/CHLORHEXIDINE should clearly state this at the pre-admission clinic as well as to theatre staff and Dr Schoeman.
- Any anti-coagulants such as Warfarin or Aspirin must be stopped 7 days prior to surgery. This may be replaced by once daily Clexane injections.
- Pre-operative blood tests are required 4 days prior to surgery.
- Patients with cardiac illnesses require a cardiologist/ physician report.
- A chest X-ray is required for patients with lung disease.
- Be prepared for an 2-3 day stay.
How is it done?
- This procedure is done under a spinal / general anaesthetic, as decided by the anaesthetist.
- A 10cm horizontal incision is made above the pubic bone.
- The retro-pubic space of Retzuis is entered.
- The para-vaginal tissue is fixed to the fascial line on the lateral to tighten the pelvic floor.
- This provides some tension.
- The wounds are closed with dissolvable sutures and/or skin glue.
- A drain is placed and the wound closed in layers.
- A urinary catheter is placed for 24hrs.
- The catheter will be removed early the next morning.
- The patient’s urine output will be measured each time they urinate and the residual will be measured. (Patients will be required to do this up to 3 times).
- If the residual amount of urine is more than 1/3 of the total bladder capacity, the patient may have to self catheterise, until the residual volume is acceptable.
- Prophylactic antibiotics will be given to prevent infection.
What to expect after the procedure?
- Any anaesthetic has its risks and the anaesthetist will explain all such risks.
- Complications: hemorrhaging, requiring blood transfusion <1%; bladder perforation, requiring an open repair <1%.
- Patients will wake up with a catheter in the urethra and bladder. This will remain in the bladder for 24 hrs.
- Incisional discomfort/pain will persist for a few days but this will subside / settle.
- If you cannot urinate after 2-3 attempts, the sling may be readjusted.
- You may be required to self catheterize for a week or two.
- NB! Each person is unique and for this reason symptoms may vary!
- Patients will have a trial of void without catheter the next day.
- Patients will be discharged as soon as they can completely empty the bladder and the drain has been removed and they can empty their bowels.
- Patients may be required to self catheterize.
- Patients may initially suffer from urge incontinence but this will improve within the next 6 weeks.
- Allow 6 weeks for symptoms to stabilise.
- There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
- On discharge a prescription may be issued for patients to collect.
- Patients are to schedule a follow-up appointment in 6 weeks.
- Please direct all queries to Dr Schoeman’s rooms.
- PLEASE CONTACT THE HOSPITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.
Burch Para-Urethral Repair (284 KB)