Rectus Sheath Fascial Sling
Product Summary: AMA rates
Harvesting and placement of a rectus sheath sling in the retropubic space combined with a flexible cystoscopy and local anaesthetic infiltration
Item number: 37042, 36812, 18262, 105
Why is it done?
- Stress incontinence.
- A combination of stress incontinence and depressor 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 overnight stay.
How is it done?
- This procedure is done under a spinal / general anaesthetic, as decided by the anaesthetist.
- The legs will be elevated into the lithotomy position.
- A 10cm horizontal incision is made above the pubic bone.
- A 10-15cm X 5cm strip of rectus shesth fascia is harvested and prepared with 2 Prolene or Nylon arms.
- A small incision is made in the vagina.
- The sling is placed behind the pubic bone and brought to the skin above the pubic bone, through the incision.
- The sling is placed with some tension.
- The bladder will be inspected with a Cystoscopy to exclude any injuries to the bladder wall.
- The wounds are closed with dissolvable sutures and / or skin glue.
- A local anaesthetic is given for pain relief.
- A urinary catheter is placed for 24hrs.
- A vaginal plug will also be placed.
- The catheter and plug 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 at least 24 hrs.
- Wound discomfort/pain will persist for a few days but this will subside / settle.
- You may be required to self catheterize for a week or two.
- If there is no improvement the sling may be cut, to allow spontaneous urination.
- 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.
- Patients may be required to self catheterize for a week or two.
- 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 HOPSITAL DIRECT WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.
Rectus Sheath Fascial Sling (309 KB)