Dr Jo Schoeman
Urological Surgeon

        

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
    • Smokers
    • Being overweight
  • Where Intrinsic Sphincter Deficiency has been proved due to a failed previous sling.
  • Failed previous incontinence procedures.

Pre-requirements

  • 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!

What next?

  • 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 Rectus Sheath Fascial Sling (309 KB)