LAPAROSCOPIC COLPOSUSPENSION

A colposuspension operation is designed to cure urinary incontinence that is caused by coughing, sneezing, laughing or exercise (stress incontinence). It may not cure urinary incontinence that is caused by urgency (or rushing to the toilet) or frequency (going to the toilet many times during the day or night). The aim of this operation is to cure incontinence by lifting up the neck of the bladder and attaching it to the back of the pelvic ligaments with some strong stitches.

The operation is performed through small keyhole cuts in the abdomen (usually 3 or 4) to allow the entry of laparoscopic instruments. These wounds are closed with dissolving stiches. A small catheter, placed through the adbominal wall (suprapubic catheter or SPC), will drain the bladder. A drip is left in your arm to allow you to have fluid until you can drink normally.

After the Operation

You will usually be in hospital for two to five days, depending on how soon your bladder starts to function again. The catheter is allowed to drain freely until Day 2, when it is closed off (clamped) at about 6 am. You will be encouraged to pass urine naturally every two- three hours. If you cannot pass urine, or are in pain, please let the nursing staff know and they will release the catheter. Each time you pass urine, the amount will be recorded by the nursing staff. Three times each day, after you have voided, the catheter will be released and the residual urine (the amount drained into the bag) will be measured. Overnight the catheter is once again unclamped and will drain freely. If the residual is less than 100mls on two occasions, and you are passing amounts of urine greater than 200mls, then the catheter will be removed and you will be able to go home. This removal is a pain free routine nursing procedure. Some patients are quicker than others to resume normal bladder function and you should not be alarmed about this; each patient is an individual. Occasionally if the bladder function is slow to return you may be allowed to go home with the catheter in place, with instructions about how to manage things.

At Home

You will need a two to four week recovery period at home. It is important to let your family know this, so that you are not expected to do too much work during this time. Get up once a night for a week after your operation to empty your bladder, as this will avoid an over-filled bladder in the morning. Gradually try and return to normal activities for the first week. Do not overtire yourself. Gradually increase the exercise you take beginning with short walks.

Some Common Questions

What are the complications of Colposuspension surgery?

There are five main complications:

1. The procedure may not work. The success rate is about 90%.

2. The bladder may be more irritable, with new symptoms of urgency and frequency in about 10-15% of women.

3. Infection of the urine, wounds or chest (treatable with antibiotics)

4. The bladder may be more difficult to empty, with about 1-2% of women needing help to empty their baldder by self-catheterisation.

5. Keyhole surgery may not be technically possible, resulting in a old-style cut over the bikini line, in about 1-2% of operations. Other rarer complications include: severe bleeding requiring blood transfusion, blood clots in the calf muscles or lungs, general anaesthetic complications, and intraoperative damage to nearby structures such as bowel/bladder/blood vessels/ureters.

When can I resume intercourse?

Sexual intercourse should be avoided until after your first check up at around six weeks. This is because the surgery will have slightly altered the shape of your vagina and intercourse in the first six weeks may be uncomfortable.

When can I go back to work?

This depends a little on your job. Most women return to work after four to six weeks. If your job is strenuous and involves heavy lifting it may take longer.

When can I drive?

You can drive after two weeks. This is because until then the abdominal wounds are still tender and if you suddenly had to turn the steering wheel to avoid an accident, and could not do so because of pain, you may be held liable for any accident caused.

When can I resume aerobics?

It is advisable to avoid strenuous exercise until after your first check up at 6 weeks. After this you may gradually resume sporting activities, although it may be several weeks before you are back to the same level of fitness as before the operation.