Sling Procedure in Kasaragod

The sling procedure in Kasaragod is a surgical method to treat stress urinary incontinence (urine leakage during physical exertion). Stress urinary incontinence (SUI) mostly occurs in women, but males are also affected. Older women and women who have given birth are more prone to develop SUI It occurs when certain activities or actions, like sneezing, coughing, lifting weights, etc., can cause the leaking of urine from your urethra (a tube that connects the urinary bladder to an opening outside the body from which the urine is passed out in males and females). This occurs due to the abdominal pressure exerted on the bladder by these activities.

The sling procedure in Kasaragod is the most common procedure used for stress urinary incontinence. The surgeon makes a sling (a strap used to suspend or carry something) from a mesh or from your own body tissue and puts it under the urethra. The sling works like a hammock, lifting and supporting the urethra and the neck of the bladder (the area where the bladder connects to the urethra). This helps in treating the leakage of urine by keeping the urethra closed. The sling is normally made from a mesh (synthetic material) or tissue from your body. Donor and animal tissue are not preferred as sling materials as the body may reject them.

The muscles in your pelvis provide support to the bladder and urethra. When these muscles are weakened, there is sagging of the bladder and urethra, which prevents the urethra from closing, thereby causing leakage of the urine from the bladder whenever pressure is exerted by the abdominal wall on the bladder (in case of coughing, sneezing, lifting weights. etc.)

Also Read: urology

The sling procedures are done to correct the stress urinary incontinence that is caused due to the sagging of the bladder neck or the urethra. Sling procedures help keep the bladder neck closed with the help of the mesh/ tissue inserted around the bladder. A sling operation is recommended when lifestyle changes like losing those extra pounds and doing exercises to strengthen your pelvic floor have failed to treat the incontinence. Different sling procedures with a high success rate and low risk of complications are used to treat SUI, mid-urethral, and traditional sling procedures.

Before undergoing the surgery in Kasaragod, it is important to prepare for it. Your surgeon will take a detailed history of your symptoms and discuss further action.

• Your surgeon will diagnose SUI by your medical history but will also perform some diagnostic imaging tests like an ultrasound of the pelvis and CT scan (Computed tomography scan) tests to confirm the diagnosis.
• You will be advised to do routine blood tests, liver and kidney function tests, chest X-rays, and electrocardiograms (ECG) to assess your overall condition before the procedure.
• Inform your doctor about all medicines you are taking. This includes prescribed and over-the-counter medicines, vitamins, herbs, and other supplements.
• Avoid the medications like blood thinners for at least 2 weeks before the procedure to minimize the risk of bleeding.
• Avoid smoking and alcohol for 2 weeks pre-procedure to prevent delayed wound healing.
• Follow all instructions for not eating or drinking before surgery; you may be asked to avoid drinking or eating for at least eight to ten hours before the procedure.
• You would be asked to wear loose-fitting and comfortable clothes on the day of your surgery.
• You will have to arrange for a family member to drive you home as you cannot drive due to the effects of anesthesia.

Sling surgery in Kasaragod is an outpatient procedure meaning that you can go home the same day after the procedure It is performed by a urologist or a gynecologist, or a urogynecologist in Kasaragod and takes 30 to 45 minutes to be completed. On the day of the surgery, the nurse will check your vitals (blood pressure, pulse, heart rate, urine output), and you will be asked to sign a consent form (to allow the surgeon to perform the procedure on you).

• You will be wheeled to the operating theater, and your anesthesiologist (a doctor who administers anesthesia and specializes in pain management) will administer general anesthesia through an intravenous line established on your arm. Antibiotics will also be given to prevent the infection from developing.
• Your groin area will be cleaned, and the hair overlying the skin will be shaved.
• The surgeon can perform 2 types of sling surgeries- Mid-urethral or traditional.

Mid-urethral is more commonly performed in which a thin mesh strip is used to make the sling. The surgeon does not use stitches to attach the sling; scar tissue is formed around it to keep it together over time. Your surgeon can put this sling under the urethra by 3 approaches:

• Retropubic approach (tension-free vaginal tape/ TVT method)- Two tiny incisions (cuts) will be made inside your vagina, under the urethra, and above your pubic bone. Through this, a needle is passed to put the sling under the urethra and behind the pubic bone. The incisions are then closed with sutures or skin glue, which will be reabsorbed by the body.
• Transoburater approach- Tiny cuts (2) will be made on the vagina, under the urethra, and other cuts on each side of the labia (lips of the vagina). The surgeon will then put the sling under the urethra.
• Single-incision mini-approach- The surgeon makes one cut in the vagina, and the sling is put through it.

Traditional Sling is similar to the mid-urethral approach, but the surgeon takes a tissue from your stomach/ thigh to make the sling or the donor’s tissue may be taken. 2 cuts are made- one in your vagina and the other in the abdomen. The surgeon will stretch the sling through the cut in your stomach, and then the sling will be stitched to the inside of the stomach wall.

Male Sling Surgery is not as common as the surgery performed in women, as SUI is more frequently seen in women than in men. In this, the surgeon makes a small incision (cut) between the scrotum (a sac-like structure located under the penis that contains the testicles) and the anus (the last part of the small intestine; feces are excreted from here to the outside of the body). The surgeon then puts the sling around the enlarged end of the urethra (urethral bulb). This leads to the urethra being lifted and squeezed, thus preventing the leakage of urine. In all the approaches, at the end of the surgery, a catheter may be put in for drainage for some days.

After the procedure, you will be sent to the recovery room for a few hours until the effect of the anesthesia wears off. Your vital signs, such as body temperature, pulse rate, respiratory rate, heart rate, and blood pressure, will be monitored. The incision site will be checked for any bleeding or oozing.

At the Hospital

• You will be given medications for pain and to reduce nausea if needed.
• If general anesthesia is given, you will be put on intravenous fluids until you pass gas. You can slowly start with liquid food and gradually resume a normal diet.
• You will be encouraged to walk around early as this helps prevent blood clot formation.
• Once your vitals are stable, you can ambulate, eat well, and have normal bowel movements, and you will be allowed to return home. In some cases of traditional sling procedures, you may need an overnight stay at the hospital.
• You will be advised to return for the checkup with your surgeon the next day after your surgery.
• Your surgeon will advise you on the medications and provide instructions at home.

At Home

• You may experience mild nausea and vomiting after surgery due to the effect of anesthesia. This will subside in 4 to 6 hours with medications. 
• You can follow a normal diet after the surgery, but it is advised to take clear liquids and semi-solids on the day of the surgery. You should drink plenty of water and eat nutritious foods. 
• Mild burning during urination may be present because of the catheter placed during surgery. This would subside in 1-2 days. The urine will be flowing in a slower stream or you may have difficulty in voiding urine - this will improve in a week. You may also experience urine retention - do not worry as this will be for a few weeks and then resolve. 
• You may notice vaginal discharge and/or vaginal bleeding for some days after surgery. This is normal and will resolve within 1 week. 
• You may have swelling, pain, and bruising over the incision site, which usually will subside within a few days with medications. 
• You can shower the next day after the procedure but do not have baths and swim for 4 weeks. Keep the incision site clean and dry. 
• Avoid any strenuous activities such as lifting heavy objects or running for about 6 weeks after the surgery. 
• Do not have sexual intercourse until the wound has healed completely. 
• You can resume work 1 to 2 weeks after surgery, but recovery takes 6 weeks.

Stress urinary incontinence is a very troublesome problem that causes embarrassment to people. After a sling surgery, patients are able to lead a good quality of life. Similarly, there are a few benefits of getting a sling surgery in Kasaragod:

• It stops urine leakage - it may lessen or stop it completely.
• Shorter procedure (30 minutes) and quicker recovery (recovery in traditional surgery may take longer).
• It is an outpatient procedure, meaning the patient can go home the same day. (Traditional surgery may require an overnight stay at the hospital).
• Minimal complications.

The sling procedure is safe and effective, but certain risks may develop afterward:

• Risk of infection with associated symptoms like high-grade fever (>103 ?), chills, and body aches due to the use of synthetic mesh.
• Rejection of the material of the sling.
• Allergic reactions to anesthesia cause hives, rash, itching, nausea, vomiting, dizziness, confusion, and breathing difficulties.
• Blood clots could dislodge in the bloodstream and travel to other internal organs like the lungs (pulmonary embolism). 
• Possible nerve damage causing numbness at the surgical site.
• Injury to the other organs like the bowel, urethra, vagina, bladder nerves, or blood vessels by the surgeon’s instruments.
• Persistent pain at the surgical site.
• Urinary complications like blood in urine, painful urination, burning while urinating, and worsening urine leakage.

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