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. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. 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:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Blood tests:

You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

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 or EKG. Sticky pads placed on your skin record your heart's electrical activity.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Pulse oximeter:

A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

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: Caregivers use this medicine to keep you asleep and free from pain during surgery. They give you anesthesia through your IV or as a gas. You may breathe in the gas through a mask or through a breathing tube placed down your throat. The tube may cause you to have a sore throat when you wake up. Regional anesthesia: Medicine is injected to numb the body area where the surgery or procedure will be done. You will remain awake during the surgery or procedure.
  
  

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.

Prevent constipation:

High-fiber foods, extra liquids, and regular exercise can help you prevent constipation. Examples of high-fiber foods are fruit and bran. Prune juice and water are good liquids to drink. Regular exercise helps your digestive system work. You may also be told to take over-the-counter fiber and stool softener medicines. Take these items as directed.

Foley catheter:

This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

Deep breathing and coughing:

This is an exercise to help decrease your risk for a lung infection after surgery. Do the following:

• Hold a pillow tightly against your incision (cut) when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breathes help open the airways that lead to your lungs. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.
  
  
• You may be given an incentive spirometer to help 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. Let out your breath and cough. Repeat the steps 10 times every hour.

Food and drink after surgery:

You will able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft food easily, you may slowly begin to eat solid foods.

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:

Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.

Medicines:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Antinausea medicine: This medicine may be given to calm your stomach and to help prevent vomiting.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• 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: This medicine makes it easier for you to have a bowel movement. You may need this medicine to treat or prevent constipation.

Oxygen:

You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

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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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