Elizabeth Kavaler, MD

Surgery: The operation is done entirely through the vagina. A very small puncture is made just above the pubic hairline, which opens the skin and fatty tissue just beneath the skin. Because this is a small incision which does not extend into the abdomen, it causes little discomfort and heals rapidly. The sutures that are used in the surgery are absorbable, so they will disappear from the body within 6 to 8 weeks from the date of the surgery. The urethra is supported by a strip of material called Proline, which is a nonabsorbable mesh that is used in hernia repairs. A 10cm by2 cm strip of Proline is loosely placed under the urethra through two small incisions in the vagina.

Risks and Complications: Complications that arise as a result of this surgery are rare. They include bleeding, infection of the suprapubic area, vaginal area, or the pubic bone, accidental injury to the bladder, pain, inability to urinate (retention), recurrent or worsening of the incontinence, appearance or worsening of vaginal vault prolapse, urgency or urge incontinence, injury to the bowel or the ureters (the tubes that bring urine from the kidneys into the bladder), vaginal pain, and vagina narrowing. In our experience, we have not needed to transfuse a patient undergoing this surgery.

After Surgery: After the operation, the vagina will be packed with antibiotic gauze which will be removed in the recovery room two hours after the surgery is over. The suprapubic catheter will be in place. It is a tube that will come out over the pubic bone and drain urine during the first few days after the surgery. The tube has a balloon at the end of' it which is inflated in the bladder and holds the catheter in place. Before discharge from the hospital, the catheter will be plugged and taped to your abdominal wall. Because 01' swelling from the surgery, you may not be able to urinate normally. This catheter will allow you to empty your bladder until you begin to urinate normally.
The catheter will be removed in the office. Once it comes out, there may be swelling that prevents you from urinating completely normally. The normal pattern of urination will return after a few days. Sometimes it takes up to two weeks after surgery to get the catheter removed and feel like things are returning to normal.

Discharge Medication You will leave the hospital with prescriptions for the following medications:
1. Antibiotic: This should be taken until the suprapubic tube is removed.
2. Pain medication: Take as directed for discomfort. If the pain is not relieved with the medication prescribed, please call the office.
3. Stool softener: Colace can be purchased over the counter at any pharmacy. The suprapubic tube can cause constipation. If you develop diarrhea, stop the stool softener. If you have severe constipation, you can use Milk of Magnesia or Metamucil.

At Home
Voiding after surgery In order to initiate the return of normal urinary patterns, you will be instructed to plug the suprapubic tube with a small plastic stopper. Allow the bladder to fill with urine normally over the course of one to three hours, and then try to urinate on the toilet without straining to empty. Spontaneous voiding can occur from immediately after surgery to a few weeks later. If you are unable to void or if you void partially, unplug the tube and drain the urine through the tube into a plastic container to measure the amount of unvoided urine. Record the result on a piece of paper, and discard the urine. Try to void again 2 - 3 hours later and repeat the process. Do not wake up at night to void unless you are awaken by the urge to empty.

Suprapubic tube care You may shower with the tube in place. It can get wet. There will always be a ring of redness around the tube and it may drain thick, yellow, brown, or red -tinged discharge. Clean the discharge off in the shower or with a little water on a tissue. A clean piece of gauze can be placed over the tube to protect your clothes from becoming soiled. Try to keep the catheter under slight tension and taped to one side of the abdomen. A small amount of urine may leak around the tube, but not too much.

Removal of the tube The urine that is left in the bladder after spontaneous voiding that you drained from the tube is called "the residual". This should be measured in ounces and any plastic cup can be used to keep track of the residuals. Once the residuals are 2 -3 ounces or less, the tube can be removed. Please call the office to arrange to have the tube removed. If your residuals are not at 2 -3 ounceS4 weeks after surgery, please call the office for an appointment.

Vaginal Drainage: Because the surgery is done through the vagina, you may experience vaginal drainage and soreness for a few weeks after surgery. The drainage may be yellow, brown, pink, or red. Ii is normal to have small amounts of drainage for 6 to 2 weeks after surgery. You may notice pieces of suture passing vaginally, as well. Do not engage in sexual intercourse for six weeks after the date of the operation

Please do not hesitate to call the office if you have concerns regarding your postoperative progress.