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Urethral Repair
What is
Urethral Repair?
This
is a surgery to control involuntary urination by
elevating the urethra and bladder.
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Effects
of Urethral Repair
Urethral repair is
usually performed to prevent urine leakage
associated with stress incontinence
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Candidates for Urethral Repair
Repair
of the bladder and urethra may be recommended
for treatment of stress incontinence (inability
to prevent urine leakage when coughing,
sneezing, laughing, jumping, walking, sitting,
or standing).
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Your Consultation
In all
urethral injuries, the location of the injury
should be localized with repeat urethrography,
antegrade cystogram through the suprapubic tube,
and cystoscopy, if needed. If an open perineal
repair is performed, the patient should be
positioned in an exaggerated lithotomy position
with the legs well padded. Deep venous
thrombosis prophylaxis with compression
stockings is preferred. Access to the bladder
via the indwelling suprapubic catheter is also
useful.
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The
Urethral Repair Procedure
Surgery is done to try and return the bladder
and urethra to its normal position. There are
two common ways of performing stress
incontinence surgery: through the abdominal wall
or though the vagina. Surgery may either require
general anesthesia, local anesthesia, or
regional (spinal) anesthesia.
You
may return from surgery with a Foley catheter or
a suprapubic catheter in place. The urine may
initially appear bloody, but this should
gradually go away. How long the Foley or
suprapubic catheter stays in place depends on
your ability to completely empty your bladder.
It may be removed several days after surgery or,
in rare cases, it may stay in place for a longer
period of time.
Another treatment option uses a cystoscope (tube
to view the bladder area) to inject a bulking
agent such as collagen into the urethra. Such
injections help make the opening of the urethra
smaller, which prevents urine loss.
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Recovery
The
amount of time it takes to recover from surgery
depends on the individual. Based on an
evaluation of your health status prior to
surgery, your health care provider can give you
a good estimate of the recovery time.
In
open repairs, the suprapubic catheter may be
removed immediately, leaving the urethral
catheter for drainage and stenting. The patient
may be mobilized on the day following surgery
and discharged when tolerating a diet.
Antibiotics are maintained for 2 weeks, and the
catheter is removed after 4 weeks. A similar
pattern is followed for the endoscopic procedure
except that the urethral catheter is left
indwelling for 6 weeks. After either type of
procedure, retrograde urethrography may be
indicated to ensure extravasation is not
occurring prior to catheter removal. This is
particularly true for patients with poor wound
healing such as people with diabetes.
In all
instances of urethral injury, follow-up should
include assessment of the patient's voiding
history, continence status, and potency.
Undoubtedly, follow-up should be life-long,
although in the trauma population this is often
difficult to achieve. Repeat cystourethrography
and cystoscopy should be used whenever changes
occur following reconstruction.
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Risks
Risks
for these types of surgeries may include:
. Bladder or urethra injury
. Incomplete cure of stress incontinence
. Urinary retention
. Overactive bladder
Risks for any anesthesia are:
. Reactions to medications
. Problems breathing
Risks for any surgery are:
. Bleeding
. Infection
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Frequently Asked Questions
Q:
What is the purpose of this procedure?
A:
Open bladder and
urethral surgeries are usually performed to
prevent urine leakage associated with
stress incontinence
(involuntary leakage of urine when laughing,
coughing,
sneezing, or lifting, which can result from
deformity or damage to the urethra and bladder
from
decreased muscle tone caused by multiple
births,
menopause, or other causes.
Q:
What should I expect after surgery?
A:
You may stay in the hospital from 1 to 2 days.
You may go home with a catheter in place. You
can usually return to your normal activities in
about 6 weeks. Avoid strenuous activity, such as
heavy lifting or long periods of standing, for
the first 3 months and increase your activity
level gradually. Straining or lifting after you
have resumed normal activities may cause a
recurrence of the problem. Most women are able
to resume sexual intercourse in about 6 weeks.
Urinary function usually returns to normal in 2
to 6 weeks.
Q:
How well does the procedure work?
A:
Experts report good results with both vaginal
and abdominal surgery to repair the bladder and
urethra, with low recurrence rates (repeated
prolapse of a pelvic organ after surgery).
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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