What's included in the package
The clinic provides a certified polypropylene loop (monofilament, macroporous - safety standard), tools for its implementation, anesthesia at a price and surgery. The patient does not need to search for and buy an implant on her own. The type of installation - retropubic or transobturator - is chosen by the surgeon based on anatomy and concomitant prolapse. The result is felt immediately after the catheter is removed: leakage during coughing and exertion stops.
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.
