Questions & Answers
Answer: At least 90% cure or ‘dry’ from the stress incontinence viewpoint. Prof Haylen believes that intraoperative ‘cough testing’ can help to ensure these high success rates.
Answer: Some mild slowing of urine flow is normal and provides a good predictor for success in curing stress incontinence. On occasions, slowing of the urine flow is more noticeable. Most women will accept this as they are happy to be ‘dry’. Less commonly again, a small residual urine volume will be present at follow up requiring urinary antiseptic tablets for some time whilst it disappears. Rarely, a small vaginal procedure may be required to adjust the tape.
- For women with significant urgency before their surgery, as well as stress incontinence, the cure rates for the urgency are not as high, thus this symptom may persist.
- Local bruising or bleeding can occur. Very rarely, a collection of blood (haematoma) can develop behind the pubic bone. If so, no treatment is generally necessary as this generally resolves over time.
Answer: Prof Haylen finds that first time (primary) repairs for prolapse using a patient’s own tissues (native tissue repair) are most successful provided all components of the prolapse are addressed. A 4 or 5 part prolapse repair is most often required involving anterior (front) and posterior (back) vaginal walls, vaginal vault (vault – using the sacrospinous ligaments) and vaginal hysterectomy (if the uterus is present and prolapsing). The posterior repair quantification (PR-Q) measurement technique (described in section 3 of “Uterine and vaginal Prolapse surgery” has enormously improved the results from all prolapse repairs.
Answer: Yes. This scenario is very common in Prof Haylen’s practice. Under generally a spinal anaesthetic, the prolapse repairs are performed first and completed, after which the tension-free vaginal tape is inserted. The patient is then asked to cough to make sure the tape is preventing leakage with coughing.
Answer: On occasions, the prolapse is associated with significant voiding dysfunction (very slow urine flow and/or a high postvoid residual). There may be a need to ensure that the voiding dysfunction is cured or alleviated with an initial prolapse repair before a continence procedure can be safely performed at a later stage, and a week or so recovering. Often the incontinence ends up not being such a problem to require the second procedure.
Answer: In dealing with tissues that have weakened once in order that the prolapse occurs, it’s not impossible that at some stage in the future, prolapse may recur. As above, it’s most important that all aspects of the prolapse are addressed in the first instance. The anterior (front) vaginal wall is a weak point with a 10-20% recurrence rate over time, more likely if this wall is prolapsing to or through the vagina prior to the first repair. Again, The posterior repair quantification (PR-Q) measurement technique (described in section 3 of “Uterine and vaginal Prolapse surgery” has enormously improved the results from all prolapse repairs.
Answer: In Prof Haylen’s belief supported by the world literature to date, no. The use of mesh can incur complications over and above that occurring with using the patient’s own tissues. Prof Haylen has had to treat many such complications which often may involve removing the mesh and starting the process of surgical cure again. A/Prof Haylen is first author (15 co-authors) and prime developer of the only classification of complications from the insertion of prostheses (meshes, tapes, implants) and grafts in urogynecological surgery (on behalf of the Terminology and Standardization Committees of the International Urogynecological Association and the International Continence Society).
Answer: These are the same as the complications from most surgeries: Bleeding, infection or delay in recovery of bowel or bladder function. Significant injury to any surrounding organ is possible but should be extremely rare.
Answer: In just about all of his prolapse and continence surgery, Prof Haylen uses a suprapubic (inserted just above the pubic bone) catheter. This is quite a small catheter. It means the patient and doctor can wait for the return of normal bladder function after the surgery. It leaves the normal passage for urine (the urethra) free. For testing the return of bladder function, the suprapubic catheter is clamped allowing the bladder to fill. When the patient feels the urge, she can try to void. Once the amount voided is over 150mls on 2-3 occasions and the residual urine volume (after unclamping the catheter for 5 minutes) is under 100mls, the catheter can generally be removed).
Answer: Professor Haylen performs all the surgery himself on patients electing to be Private patients.