This is an information resource designed to help you understand the nature of a medical condition and the surgical procedure most commonly used to treat it.
What is the Mesh Sling Procedure for Stress Urinary Incontinence in Women?
SUI is a problem when the pelvic muscles that support the bladder and urethra, or the urethral sphincter are weak. Support problems can start from pressure on these muscles with pregnancy and childbirth, chronic constipation, extra body weight, smoking, coughing and certain activities like heavy lifting that are repeated often.
What is the Mesh Sling Procedure for Stress Urinary Incontinence in Women?
SUI is a problem when the pelvic muscles that support the bladder and urethra, or the urethral sphincter are weak. Support problems can start from pressure on these muscles with pregnancy and childbirth, chronic constipation, extra body weight, smoking, coughing and certain activities like heavy lifting that are repeated often.
[x_columnize] Your doctor has recommended a mesh sling to treat your stress urinary incontinence. Before we talk about this surgical option, let’s review some information about the female body and this medical condition.
The female bladder is behind the pubic bone and on top of the vagina. It is in the pelvis, the lowest part of the body between the hips.
The bladder muscle squeezes to empty urine through a short tube called the urethra. This tube lies under the pubic bone and in front of the vagina.
The urethral sphincter is a muscle at the opening to the bladder. You control urination by relaxing and squeezing this muscle. Stress urinary incontinence, SUI (say S-U-I) is uncontrolled urine leaking from pressure on the bladder and urethra. This pressure happens with sneezing, coughing, laughing and exercise.
SUI is a problem when the pelvic muscles that support the bladder and urethra, or the urethral sphincter are weak. Support problems can start from pressure on these muscles with pregnancy and childbirth, chronic constipation, extra body weight, smoking, coughing and certain activities like heavy lifting that are repeated often.
Other risks for female SUI include
low estrogen and menopause
genetics, meaning a woman can be born at risk for weak tissue
and it can be an occasional side effect of pelvic surgery
Some changes can make leaking better without surgery, drink smaller amounts at a time, quit smoking if you smoke and work to get to a healthy weight if you are overweight.
Another way to help stop leaking without surgery is to make pelvic muscles stronger with Kegels, also called pelvic floor exercise. These exercises can help before and after incontinence surgery.
Physical therapists can help with these exercises. They will sometimes use biofeedback therapy to test if you are exercising the right muscles. Other tools for this therapy are electrical stimulation and vaginal weights. If exercise and other changes have not helped stop the leaking then bulking agents may be an option. Silicone microbeads or another material is injected into the urethra to make the wall thicker so that it closes more tightly. Many patients are better after this but the leaking eventually returns for most. The injection may be repeated.
Bulking agents are most helpful for people with mild SUI, for patients not ready for surgery and patients that cannot or should not have surgery.
The sling procedure is a permanent surgical treatment option for women with problem leaking from SUI.
A sling is a ribbon which can be made of human tissue or plastic fabric called mesh. The ribbon is looped under the urethra during surgery, to create a sling or hammock. This adds support for the weak tissues and urethral sphincter and helps stop leaking for most patients.
Your surgeon has recommended a mesh sling for you. This means that your sling will be made of a ribbon of plastic fabric called polypropylene.
The main benefits to using mesh instead of human tissue are
mesh slings are faster and easier to place
less time is spent in surgery
incisions are smaller
so healing is faster than if the sling was made from your own tissue.
Mesh slings have been used to treat SUI for over 15 years. About 8 out of 10 women have no leaking or are drier after this procedure. As with any surgery, there can be problems or complications for some patients.
Mesh exposure in the vagina is one problem that can affect about 3 percent or 3 in 100 women after a mesh sling. This is when a piece of the mesh is not completely covered by the vaginal wall after healing.
A small edge of the mesh can be felt by the patient or their partner as a screen or gritty patch in the vagina. This can usually be fixed with a minor procedure to trim and cover the mesh. If the exposed mesh is not causing the patient any problems, it can be safe to leave untreated, and repair if new problems develop. Mesh exposure is more common in patients that have thin delicate vaginal tissue from low estrogen. You may be advised to use estrogen vaginal cream before or after surgery. Rarely, the mesh causes painful scar tissue, erosion or damage to the bladder or urethra. Some problems, especially pain are not able to be fixed with surgery.
There are three main types of mesh sling procedure: mini sling, retropubic and transobturator (say trans-ob-tur-A-tor) . Each way of placing the mesh has its own risks and benefits.
Mini Slings are the newest procedure. They use the smallest size mesh and only need one small vaginal incision to place. But we are still learning about how well these work and the problems that patients may have.
The retropubic sling procedure guides the mesh using the pubic bone in front of the bladder. This has the highest risk of a small hole being poked in the bladder. These injuries usually heal quickly if seen and treated at the time of surgery. This type of sling is the best-studied with proven long-term benefits.
The transobturator procedure guides the mesh in from the side and bottom of the pubic bone. This is away from the bladder so there is less risk of bladder damage. Two small incisions are needed in the groin or leg crease to place this mesh. A risk of this procedure is pain from these groin incisions for some patients.
Mesh is permanent. During healing your tissues grow into the mesh. Surgery to remove it can be difficult or impossible to do.
Experts haven’t agreed that any one sling procedure is the best. The procedure recommended for you depends on your surgeon’s experience and training and your individual situation. Be sure you understand which procedure and sling material is planned for you.
Let’s talk about what happens during a Mesh sling procedure.
To start, you are given anesthesia to keep you free of pain during the procedure. You are positioned carefully. A thin soft tube called a Foley may be placed in your bladder.
A tool called a retractor is gently used to enable the surgeon to reach and operate on the front wall of the vagina. Here an incision is made.
If you are having a mini mesh procedure, this will be the only incision. The small piece of mesh is gently positioned under the urethra and the incision is closed. If you are having a retropubic mesh procedure, the vaginal incision is made followed by 2 small skin incisions above the pubic bone.
If a trans-obturator procedure is done, the vaginal incision is made, followed by 2 small skin incisions in the groin-crease of the upper-thighs.
For the retropubic and trans-obturator procedures, special tools are used to guide the sling into position under the urethra. The tools and the way they are used vary for the different procedures and kits.
The mesh is gently positioned to support the urethra without crushing or pressing on it. This is called tension free. The ends of the mesh are cut to the needed length. The mesh holds itself in position.
A cystoscope is gently placed thru the urethra to the bladder and the bladder is filled with water or saline.
This scope has a light and a camera and is used to help the surgeon see the inside of the urethra and bladder during the procedure and after the sling is placed. The surgeon checks for bleeding, holes in the bladder and for mesh or tools where they should not be. At the end of the procedure, a foley may be placed.
The vaginal incision and skin incisions are closed.
Shoulder Joint Replacement Surgery | Patient Education • PreOp.com PreOp® Website: https://PreOp.com StoreMD™: https://store.preop.com Patient Education Company Your doctor has told you that need to undergo shoulder replacement surgery. But what does that actually mean? As you move your arm, the ball-shaped end of the upper arm, or humerus, moves against a cup-like depression in shoulder bone, or scapula. As long as the upper arm can slide against the shoulder, you are able to move your arm comfortably. But over time, especially in patients who suffer from arthritis, the shoulder joint can wear down. Cartilage, the tissue that cushions the bones and makes it possible for them to move smoothly against each other can wear away. When this happens, the bones run together, causing pain and restricting arm movement. No matter what the cause, one of the most effective ways to fix a damaged shoulder is to replace it surgically. In this procedure, the ball-shaped bone at the top of the…
A shoulder replacement is a surgical procedure in which the ball-shaped bone at the top of the upper arm is removed and replaced with a metal substitute.
PreOp® Patient Education: Shoulder Joint Replacement Surgery
Your doctor has told you that need to undergo shoulder replacement surgery. But what does that actually mean?
As you move your arm, the ball-shaped end of the upper arm, or humerus, moves against a cup-like depression in shoulder bone, or scapula.
As long as the upper arm can slide against the shoulder, you are able to move your arm comfortably. But over time, especially in patients who suffer from arthritis, the shoulder joint can wear down.
Cartilage, the tissue that cushions the bones and makes it possible for them to move smoothly against each other can wear away.
When this happens, the bones run together, causing pain and restricting arm movement. No matter what the cause, one of the most effective ways to fix a damaged shoulder is to replace it surgically.
In this procedure, the ball-shaped bone at the top of the upper arm is removed and replaced with a metal substitute.
The shoulder socket is widened and lined with a smooth pad that allows the metal ball joint to move more freely against the shoulder blade.
Shoulder replacement surgery is a major operation, but your doctor believes that the procedure -- followed up with physical therapy and time to heal -- will result in reduced pain and greater mobility.
Your Procedure:
On the day of your operation, you will be asked to put on a surgical gown.
You may receive a sedative by mouth and an intravenous line may be put in.
You will then be transferred to an operating table.
In the operating room, a nurse will prepare by clipping or shaving the skin around the shoulder.
The anesthesiologist will begin to administer anesthesia - most probably general anesthesia by injection and inhalation mask.
The surgeon will then apply an antiseptic solution to the skinand place a sterile drape around the operative site.
Then, when you are asleep, the surgical team will make an incision over the shoulder.
The team will pull the skin aside to reveal the muscle tissue below. They'll then make another incision to reveal the shoulder joint.
Next, the team pulls the top of the arm bone out of the shoulder socket.
Using a precision surgical saw, your doctor will carefully remove the ball-shaped end of the upper arm.
Then, the surgical team will use a high-speed drill to hollow out the top of the arm bone.
A specially fitted artificial ball joint slides into the top of the arm bone.
Next, your doctor will smooth the inner surface of the shoulder socket.
Once the socket has been thoroughly cleaned, the artificial lining will be secured in place.
The artificial ball joint is turned inward and fit into the socket... and the team carefully checks to make sure that it fits and allows the full range of normal motion.
Muscle and other tissues are closed over the joint using dissolvable stitches. A temporary draining tube may be added.
When you have reflux disease, the weakened muscle allows the contents of your stomach to back up into your esophagus. This can cause considerable discomfort, chest pain and belching.
AntiReflux Laparoscopy Surgery - PreOp® Patient Education PreOp® https://PreOp.com & StoreMD™ https://Store.PreOp.com Patient Education Company Your doctor has recommended that you have an upper GI endoscopy. But what does that actually mean? An upper GI endoscopy is a diagnostic procedure used by your doctor to inspect the inside of your throat, esophagus, stomach and upper intestine. While it’s considered a surgical procedure, endoscopy does not involve an incision. Instead, your doctor will pass a flexible tube, called an endoscope through your mouth and into your stomach and digestive tract. This tube has a tiny video camera mounted on its tip, it also contains a small tool used for taking tissue samples. Because the passageway from the mouth to the opening of the small intestine is usually unobstructed, your doctor can use the endoscope to inspect the entire upper half of your digestive system. Reasons for undergoing an upper GI endoscopy vary. You may have been suff…
Your doctor has recommended that you have an upper GI endoscopy. But what does that actually mean?
An upper GI endoscopy is a diagnostic procedure used by your doctor to inspect the inside of your throat, esophagus, stomach and upper intestine.
While it's considered a surgical procedure, endoscopy does not involve an incision. Instead, your doctor will pass a flexible tube, called an endoscope through your mouth and into your stomach and digestive tract.
This tube has a tiny video camera mounted on its tip,
it also contains a small tool used for taking tissue samples.
Because the passageway from the mouth to the opening of the small intestine is usually unobstructed, your doctor can use the endoscope to inspect the entire upper half of your digestive system.
Reasons for undergoing an upper GI endoscopy vary. You may have been suffering from one or more of a number symptoms - including weight loss, abdominal pain, chronic heartburn or indigestion, gastritis, hiatal hernia, trouble swallowing, pain caused by an ulcer or other problems associated with the stomach and digestive system.
Some gastrointestinal symptoms can be warning signs of serious medical problems and you should take your doctor's recommendation to have an endoscopy very seriously.
Luckily, the vast majority of medical problems diagnosed by endoscopy are treatable and you should look forward to improved health and comfort as a result of the information gathered during the procedure.
Your Procedure:
On the day of your operation, you will be asked to put on a surgical gown, you may receive a sedative by mouth
and an intravenous line may be put in.
You will then be transferred to the operating table, and positioned comfortably on your left side.
A nurse will begin preparation by spraying a liquid anesthetic into your throat.
To help you hold your mouth open, a small mouth piece will be placed between your teeth.
To create a better viewing area, your stomach will be filled with a small quantity of air which may cause you to have a feeling of fullness.
After a few minutes, your mouth and throat will feel numb.
The doctor will then insert the endoscope into your mouth and gently guide it towards your stomach and small intestine.
To better examine abnormal-looking tissues, your doctor may choose to take one or more biopsies.
Small instruments sent through the interior of the endoscope are able to painlessly remove small samples of tissue with a small scissor like tool by simply snipping them free.
After a thorough exam, the endoscope is carefully removed... and the support piece is taken out of your mouth.
Any tissue specimens removed during the procedure will be sent immediately to a lab for microscopic analysis. Your doctor will tell you when to expect results from those tests.
You have a Foley catheter in place to drain urine. This video will help you to understand how to care for the catheter and the drainage collection bag.
How do you care for a catheter and drainage collection bag for a male?
You have a Foley catheter in place to drain urine. This video will help you to understand how to care for the catheter and the drainage collection bag.
Start all care by washing your hands with soap and water for 20 seconds, and dry them.
If you are doing the foley care for another person, put on disposable gloves after hand washing. This is for your own protection, even if you are caring for a family member.
Using a fresh clean washcloth, warm water, and mild soap, wash the skin around the catheter, penis, and scrotum. This area must be cleaned every day to prevent infection. Also wash the catheter, especially where it is close to the skin. You may shower to stay clean but do not soak in a bathtub.
Patient Education
When you are finished dry the skin with a clean towel.
A small dab of bacitracin antibiotic ointment or Vaseline may be put on the tip of the penis to make the catheter more comfortable. Do not touch the skin with the tube.
Next, you may change the large overnight urine bag to a small leg bag to make it easier to move around during the day.
Before changing the bag, take off your dirty gloves and wash your hands and put on fresh clean gloves.
Put your supplies where they are easy to reach. You will need a clean or new leg bag, clean towel and alcohol wipes.
Place a clean towel under the connection of the catheter to the drainage tube.
Patient Engagement
Clamp the collection bag tubing so that it will not spill. Next, hold the catheter and the bag tubing where they meet and gently pull them apart.
To connect a new leg bag, remove the cap from the top of the bag and gently push the tip into the catheter without touching the tip with your fingers.
If you are re-using a bag, clean the tip with an alcohol wipe before connecting.
Strap the bag to the leg. Not loose enough that it could get tangled, but not so tight that it pulls on the catheter.
Be sure the drainage spout on the bottom of the bag is closed.
To change back to the large, overnight bag you will repeat the same steps.
The catheter must be lower than your bladder and hips to drain and keep the bladder empty. Hang the large bag next to you on your bed or chair, do not lay it on the floor.
If the catheter is not draining check the tubing to see if it is kinked or pinched. You can try gently moving the drainage tubing up and down then tipping it toward the floor to get it to drain.
If a bag has been disconnected and will be used again sometime later, it must be cleaned.
Patient Education
Before cleaning the bag, empty any urine into the toilet using the bottom spout. Do not let the spout touch any part of the toilet.
Then wash and rinse the outside of the bag.
Next, to clean the inside of the bag you will need a large syringe, a measuring cup, and white vinegar.
First, rinse the inside of the bag with plain warm water. You can use the syringe to push water thru the tubing into the bag. Let the water drain out and close the bottom spout.
Next mix 1 cup of water with one cup of white vinegar. Use the syringe to put the vinegar water mixture into the bag. Close the drainage tubing and let the bag sit for 30 minutes or one half hour.
Then open the bottom drain to empty the vinegar mixture from the bag. Rinse the bag again with plain water.
Use the syringe to put some air into the bag and with all connections open, hang the bag to dry.
Do not reuse a bag that has not been properly cleaned because it may cause infection.
When you are finished, remove your gloves and place in a trash container. Wash and dry your hands.
Patient Engagement
Call your doctor if
your catheter will not drain,
if you have a fever, chills or back pain,
for bleeding
if your urine has a strong bad odor
and call if you have pain at the catheter site, where it goes into your body.
This video is intended as a tool to help you to better understand the care instructions that you have been given. It is not intended to replace any specific advice or personal care instructions that you have received from your care team. If you have any questions or problems please be sure to call or be seen.
TURP Transurethral Resection Prostate Surgery, patient education series PreOp® https://PreOp.com & StoreMD™ https://store.preop.com Patient Education Company Your doctor has recommended that you undergo a Trans Urethral Resection of the Prostate - or TURP. But what exactly does that mean? Your Procedure: On the day of your operation, you will be asked to put on a surgical gown. You may receive a sedative by mouth and an intravenous line may be put in. Once on the table, your feet and legs will be placed in an elevated position with your knees apart. The nurse will swab the penis with an antiseptic solution. Your doctor will then lift your penis upward. A well-lubricated instrument called a resectoscope is then gently inserted into the urethra. When the resectoscope reaches the back of the penis, your doctor will pull the penis downward in order to create a straight path into the prostate. Using this tool, your doctor will then scrape excess tissue from the prostate, restor…
