The place of cystopexy in modern surgery
Sling operations have almost replaced cystopexy due to their simplicity and quick recovery, however, MMMC remains in demand when another operation through the abdomen (hysterectomy, prolapse correction) is simultaneously performed, in case of relapses after slings, and also when it is impossible to use a synthetic implant. With sutures placed on the paraurethral tissue, the neck of the bladder is fixed to the pubic bone, restoring the normal angle of the urethra. Long-term effectiveness is 75–85%. Recovery is longer than after TVT: 3–5 days in hospital, 6 weeks without exercise.
Indications
- stress urinary incontinence (when coughing, sneezing, laughing, running, lifting heavy objects) II–III degree;
- ineffectiveness of pelvic floor muscle exercises and physical therapy for 3–6 months;
- mixed incontinence with a predominance of the stress component;
- relapse after previously performed operations;
- mild degree or contraindications to surgery - introduction of a volume-forming gel;
- combination with prolapse - cystopexy or combined operation.
For urgent incontinence (sudden uncontrollable urges), the sling does not help - medications and botulinum toxin therapy for the bladder are used.
Sling surgery TVT / TVT-O
Under spinal or intravenous anesthesia, a 1-1.5 cm incision is made on the anterior wall of the vagina under the middle part of the urethra. A thin polypropylene mesh tape 1 cm wide is passed through it: with TVT, its ends are brought out behind the pubic bone through two punctures above the pubis, with TVT-O/TOT - through the obturator foramina to the inner surface of the thighs. The loop is placed without tension - it does not tighten the urethra, but creates a support that only works when tension is applied. The incisions are closed with absorbable sutures, the loop grows through the tissue and is not felt.
The operation takes 20–30 minutes; the catheter is removed on the same day or in the morning, and the patient is discharged after urinating independently. The result is immediately visible: coughing stops. Efficiency after 5–10 years is 85–95%. The price list of the clinics below shows options with loops from different manufacturers.
Volume-forming gel and cystopexy
The introduction of the gel is an outpatient procedure under local anesthesia: under the control of a urethroscope, a gel-forming drug is injected under the mucous membrane of the urethra at 2-3 points, narrowing the lumen and increasing the closure. Suitable for mild cases, for elderly patients and for contraindications to surgery; the effect is 60–70%, sometimes requires repetition after 1–2 years.
Cystopexy (Marshall-Marchetti-Krantz operation) - fixation of the bladder neck and urethra to the pubic bone using open or laparoscopic access; Today it is used when incontinence is combined with prolapse or during simultaneous operations on the pelvic organs.
Preparation and recovery
Diagnostics: conversation and urination diary, cough test on a chair, ultrasound with residual urine, uroflowmetry; with mixed symptoms, a urodynamic study is performed to distinguish stress incontinence from urge incontinence. Tests: general analysis and urine culture, blood test, coagulogram, smear. The operation is planned outside of menstruation.
After surgery: 1 day in the hospital, mild discomfort for 2–3 days. For 4–6 weeks, you should not lift more than 3–5 kg, play sports or be sexually active; It is important to avoid constipation and cough. Work - in 7-10 days. Control examinations after 1 and 3 months.
Treatment of urinary incontinence in Tashkent
In the clinics below, urologists and urogynecologists perform TVT/TVT-O sling operations with certified loops, injection of volume-forming gel and cystopexy, and there is urodynamic diagnostics. Prices according to the clinic’s price list (with and without the cost of the loop); Anesthesia is paid separately. Sign up for a consultation - the examination will take one visit.
