Minimally invasive procedures for Stress Incontinence that can be performed in our office ASC include:
Macroplastique is made from the same inert substance that is used for cosmetic dermal fillers in the face. It can be placed around the neck of the bladder to help the bladder form a seal. It is of particular usefulness when intrinsic sphincter deficiency is present. It is placed under IV conscious sedation and only takes a few minutes.
Classic slings remain the gold standard procedure for urinary stress incontinence. They are an outpatient procedure, and can be done in a hospital operating room or in our office OR suite. Typically they are placed under IV sedation and you go home the same day. There are different types of slings and different ways to place them depending on your circumstances. They work well for both regular stress incontinence, and for intrinsic sphincter deficiency. Here’s what happens: A tape is inserted under the urethra and brought out through two small incisions above the pubic bone (retropubic e.g., IVS, TVT, SPARC) or in the groin (transobturator e.g., Monarc, TVT-O) on each side. There is a fibrous reaction around the tape, which acts as an artificial ligament to strengthen and replace the weakened ligament. The tape also acts as a hammock below the urethra, and provides a backboard. A small repair is then performed under the urethra to further protect the tape. No vaginal pack or catheter is required. Complications are unusual – your provider will discuss the risks and benefits. You should be aware however, that slings have recently come under fire in the media because of mesh exposures. This is a condition in which the vaginal incision retracts and the mesh becomes exposed. This is a foreign body reaction. It happens 2-5% of the time. It is fairly easily addressed, but does require a trip back to the procedure room, with IV sedation usually, to trim the mesh, or remove the exposed part completely, (rarely the entire mesh is removed), and re-approximate the vaginal incision. Continence is usually but not always maintained after a mesh exposure is repaired.
Mini-slings are a less invasive option that can easily be placed in the office procedure room with IV sedation. They are a good option for mild to moderate stress incontinence. They seem to, in the studies done to date, have the similar results, although that has not been the personal experience at our clinic. Mesh exposures still do occur 2-5% of the time, as with the classic sling.
Minimally invasive procedures for Overflow Incontinence that can be performed in our office ASC include:
Before placing an Interstim device, we usually start with a simple “percutaneous test” to see if you would respond well to an Interstim device. This is a simple test and lasts about 3-4 days. That way, you can see how it might work for you without committing at this point to a long term treatment. No incisions are involved, and the procedure can be done in the office or in an ASC or outpatient surgical center. For more information on the trial assessment or “perc test”, click here.
At this point, we are not able to implant the actual Interstim lead, but this may become available in the future. At present the actual Interstim lead and generator are placed in the hospital setting, where we have access to X-ray guidance.