Consumer Information

Transvaginal Bladder Neck Suspension

WHAT YOU SHOULD KNOW:

Transvaginal bladder neck suspension is surgery to treat stress incontinence (in-KON-tih-nence). Stress incontinence is when urine leaks with straining. This may happen when you are lifting heavy items, coughing, sneezing, or laughing. Transvaginal means that the surgery is done through your vagina (birth canal). The goal of surgery is to move the bladder and urethra back into their correct positions. Doing this may correct stress incontinence. The bladder is the organ that holds urine before it leaves the body. The urethra is the tube that carries urine from your bladder to the outside of your body.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

There are always risks with surgery. You may bleed more than usual, get a urinary tract or wound infection, have trouble breathing, or get blood clots. The surgery could block the outlet of your bladder causing irritation and trouble urinating. A fistula (abnormal path) could develop, causing urine to stay in your body, instead of going out your urethra. Your caregivers will watch you closely for these problems and work to prevent or treat them.
If you do not have surgery, your incontinence could get worse. Call your caregiver if you are worried or have questions about your medicine or care.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.

Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.

Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.

IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.

Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.

Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.

Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.

Anesthesia: This is medicine to make you comfortable during surgery. You may be awake or completely asleep. You and your caregiver will decide which type of anesthesia is best for you. Ask your caregiver for information about anesthesia if you want to know more about it. The different types of anesthesia that could be used for this surgery are:

General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery. Spinal or epidural anesthesia: This is medicine put into your back to numb you below the waist. With spinal anesthesia, the medicine is given through a shot. Feeling returns in about two hours. Epidural anesthesia is put into your back through a tiny tube. The tube may be left in place to give you more medicine later if needed. After epidural anesthesia, feeling returns to your legs when the medicine wears off.

During Surgery:

Your legs are put up in low stirrups (leg holders) and then your perineum (the area between your legs) may be shaved. A caregiver cleans your perineum, vagina, and abdomen with soap and water. This soap may make your skin yellow, but it is cleaned off later. Sheets are put over you to keep the surgery area clean. A catheter will be put in to drain your urine. It may be put in through a small incision (cut) through your abdomen, and into your bladder. It may be put into your urethra (the tube that goes from your bladder to the outside of your body) instead of through your abdomen.
An incision is made in your vagina. A second incision may be made in your lower abdomen. Stitches (thread) are put in the tissue around your bladder to hold it up against your abdominal wall. This helps prevent urine from leaking when you strain. The incisions are closed with stitches. Gauze packing with medicine cream is put inside your vagina. This helps healing and decreases the chance of infection.

After Surgery: You are taken to a recovery room where you are watched closely until you wake up. Feeling will return to the surgery area. You may be allowed to go home right away, or you may need to stay in the hospital. If you are staying in the hospital, you will be taken to your room. Do not get out of bed until your caregiver says it is OK. A small bandage is used to cover the stitches on your abdomen. This bandage keeps the area clean and dry to prevent infection. The gauze packing in your vagina may feel uncomfortable. Caregivers will remove the packing as soon as possible, usually within 1 to 3 days.

Bowel movements: Exercise such as walking can help you have regular bowel movements. Including foods such as fruit, bran, and prune juice, and drinking enough water can also help. Caregivers may give you fiber medicine or a stool softener to help make your BMs softer and more regular.

Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.

Deep breathing and coughing: This breathing exercise helps to keep you from getting a lung infection after surgery. Deep breathing opens the tubes going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. You should deep breathe and cough every hour while you are awake even if you wake up during the night.

Hold a pillow tightly against your incision (cut) when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while awake. Remember to follow each deep breath with a cough.
You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your incentive spirometer 10 times in a row every hour while awake.

Diet: You may be able to eat when bowel sounds are heard. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, juice, or soda pop. If you do not have problems after drinking liquids, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.

Ice: Ice causes blood vessels to constrict (get small) which helps decrease inflammation (swelling, pain, and redness). Ice is best started after surgery and for the next 24 to 48 hours afterwards. Put crushed ice in a plastic bag and cover it with a towel. Place this between your legs for 15 to 20 minutes every hour as long as you need it. Do not go to sleep with the ice pack in place because you may get frostbite.

Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.

Medicines:

Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Medicine may be given regularly, or may only be given if you ask caregivers for it. Tell caregivers if your pain does not decrease enough for you to feel better. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it. Ask your caregiver for help getting out of bed if you feel tired or dizzy.
Patient Controlled Analgesia: This is also called "PCA". Caregivers may put a machine on your IV pole that puts pain medicine into your IV. You may be taught how to give yourself the pain medicine by pushing a button whenever you feel pain.
Stool softeners: You may be given stool softeners to soften your bowel movements, making them easier to pass.

Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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