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Stress Urinary Incontinence

Why is it done?

  • Stress incontinence
  • A combination of stress incontinence and detrusor over-activity of which DO the lesser
  • 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


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 sheath 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-catheterize, until the residual volume is acceptable.
  • Prophylactic antibiotics will be given to prevent infection.



  • 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.
  • The sling may be loosened if placed too tight, requiring going back to the operating room.
  • Patients may initially suffer from urge incontinence but this will improve within the next 6 weeks.
  • Allow 6 weeks for symptoms to stabilise.
  • May also have abdominal pain with coughing and sneezing due to tension on rectus muscle
  • There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.


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Copyright 2019 Dr Jo Schoeman