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In this section, routine gynecological procedures for bladder repair,
fertility and pregnancy are explored. They include the following:
Before, During and After for each procedure
will give you an idea of what to plan for
prior to going to surgery. Keep in mind
that everyone's experience may be different.
Anterior Repair - Colporrhaphy
Stress urinary incontinence is basically defined as the involuntary leakage of urine. The Anterior
Repair- Colporrhaphy procedure is performed to relieve the incontinence related to sneezing,
coughing or with any physical exertion or high-level exercise.
This condition affects anywhere from 15 to 50% of adult
females depending on age, risk factors and varies
in the degree of severity. Causes can range from,
but are not limited to:
obesity, advanced age, high level of physical activity,
amount of fluid intake, strength of the pelvic
floor muscles and urethral sphincter and childbirth.
The muscles of the pelvic floor weaken causing the vaginal
wall to give way. The result is called a
cystocele. Here it may include the muscles surrounding
the urethra that
help it contract closed. When this occurs, then
it must be repaired at the site where the vaginal vault and
bladder/urethra are tacked to the surrounding
musculature.
Before
Prior to the procedure your physician may require labwork and/or
a chest x-ray. Wear loose-fitting clothing to the hospital
so that upon discharge you will be able to get dressed easily
without too much strain or discomfort. Do not eat for at least 8
hours before the procedure as it is performed using general
anesthesia (go to sleep) which requires the stomach to be empty.
During
An anesthesiologist will
maintain your airway and other bodily functions
during the procedure. Your family/other may wait in the waiting room
during the procedure. A nurse will keep your family apprised of your progress.
After
You will go to a recovery area for a while to make sure that you are fully awake. After you
meet the nursing/medical criteria to be discharged from post-anesthesia, you will be taken to a
regular patient floor for further recovery. The amount of post-op pain varies from patient to
patient but should be relatively minor. Your surgeon will advise you regarding lifting, jogging
or doing any strenuous exercise during your period of recovery at home.
- Nutrition: Eat a well
balanced diet to help your body heal.
Choose low-fat dairy products, lean meats,
fruits and vegetables, whole grain breads
and cereals. Drink plenty of fluids (6-8
glasses a day), unless told to limit fluids
for other conditions.
- Medications: Take your
medicine exactly as instructed. If taking
pain pills, take with food and do not
drink alcohol or engage in activities
that require mental alertness.
- Activities: Gradually
resume activities. No heavy lifting, pushing,
or pulling. No straining. Avoid constipation.
- Special Care: If you have
an incision keep it clean and dry. If
you go home with a catheter, specific
instructions will be given.
Signs to Report
Call your physician if you have any of the following symptoms:
- Temperature of 101 or greater
- Inability to void
- Pain or burning with urination
- Urine has foul odor or cloudy appearance
- Any drainage or redness around incision
Let your doctor know if some part of this
routine is not working for you. Remember
your follow-up appointment. If your have
questions or concerns call your physician.
Sling Procedure for Stress Urinary Incontinence
Stress urinary incontinence is basically defined as the involuntary leakage of urine and this procedure
is performed to relieve the incontinence related to sneezing, coughing or with any physical exertion
or high-level exercise.
This condition affects anywhere from 15 to 50% of adult
females depending on age, risk factors and varies
in the degree of severity. Causes can range from,
but are not limited to: obesity,
advanced age, high level of physical activity,
amount of fluid intake, strength of the pelvic
floor muscles and urethral sphincter and childbirth.
There are several types of implants
(various companies)
used. The surgeon will determine which type is
the best for the patient. Various non-surgical
testing such as urodynamic testing, urinalysis,
postvoid residiual volume and cystometry may
be done in the
realm of treatment.
Before
Wear loose-fitting clothing to the hospital so
that upon discharge you will be able to get dressed
easily without too much
strain or discomfort, do not eat for at least
8 or more hours before the
procedure as it is performed using general anesthesia
(go to sleep) which requires the stomach to be
empty.
During
An anesthesiologist will
maintain your airway and other bodily functions
during the procedure. Your family/other may wait in the waiting room
during the procedure. A nurse will keep your family apprised of your progress.
After
You will go to a recovery area for a while to make sure that you are fully awake. After you meet
the nursing/medical criteria to be discharged from post-anesthesia, you will be taken to a regular
patient floor for further recovery. The amount of post-op pain varies from patient to patient but
should be relatively minor. Your surgeon will advise you regarding lifting, jogging or doing any
strenuous exercise during your period of recovery at home.
- Nutrition: Eat a well balanced diet to help your body heal. Choose
low-fat dairy products, lean meats, fruits and vegetables, whole grain breads and cereals.
Drink plenty of fluids (6-8 glasses a day), unless told to limit fluids for other conditions.
- Medications: Take your medicine exactly as instructed. If taking pain pills,
take with food and do not drink alcohol or engage in activities that require mental alertness.
- Activities: Gradually resume activities. No heavy lifting, pushing, or pulling.
No straining. Avoid constipation.
- Special Care: If you have an incision keep it clean and dry. If you go home
with a catheter, specific instructions will be given.
Signs to Report
Call your physician if you have any of the following symptoms:
- Temperature of 101 or greater
- Inability to void
- Pain or burning with urination
- Urine has foul odor or cloudy appearance
- Any drainage or redness around incision
Let your doctor know if some part of this routine is not working for you. Remember your follow-up
appointment. If your have questions or concerns call your physician.
Hysterosalpingogram Procedure
A hysterosalpingogram is a study of the female reproductive system outlining the uterus and
fallopian tubes. The procedure is done as part of the basic infertility evaluation.
The test is usually done in the radiology department of the hospital during
which radiographic contrast (dye) is injected into the uterine cavity through the vagina and
cervix. The uterine cavity fills with dye and if the fallopian tubes are open the dye will
then fill the tubes and spill out into the abdominal cavity. This can show whether the fallopian
tubes are open or blocked and whether the blockage is located at the junction of the tube and
the uterus (proximal) or whether it is at the end of the fallopian tube (distal). These two
areas where the tube is most commonly blocked have different causes. Effective treatment for
tubal factor infertility is available.
There are other things that potentially can be seen
on a hysterosalpingogram other than whether
the tubes are open or blocked. The uterine cavity is evaluated for
the
presence of polyps or fibroid tumors or scar tissue.
The fallopian tubes are also examined for any
defects within the tube or suggestion of a partial blockage. If you
have additional
questions, ask your physician or nurse.
Before
The procedure must be scheduled within 10 days from the last day of your menstrual cycle.
Your physician's office will schedule this procedure. The actually test is done in the
radiology department and should only take from 5-10 minutes, but additional time should be
planned for to register at the facility and fill out questionnaires regarding allergies to
medications, etc.
During
- You will change into a hospital gown. The radiologist will come into the room
and explain your test and answer any questions.
- You will lay on the x-ray table in a position similar to having a pap smear
at your physician's office.
- A speculum will be inserted into your vagina by the physician to visualize
the cervix.
- The radiologist will then insert a tube into your uterus and inject dye/contrast.
- An x-ray picture is taken as the uterine cavity is filling and then additional
ink/contrast is injected so that the tubes should fill and begin to spill into the abdominal
cavity.
- Additional x-rays are taken as this "fill and spill" occurs.
- When both tubes are demonstrated to be patent (or blocked), you will usually
be asked to roll to one side or the other slightly to give a slightly oblique x-ray image
which may help to further delineate your anatomy.
- The procedure is now complete. The instruments are removed from the cervix
and vagina. You should remain on the table for several minutes to recover from the cramping
which usually accompanies injection of the dye/contrast.
After
- After the procedure you
can get dressed and leave the hospital.
- The radiologist will send
a report to your physician within 24-48
hours.
- You may experience some
soreness, discharge and discomfort.
- Wear a sanitary napkin
for several hours due to drainage of dye
and/or spotting.
- Call your physician if
you have excessive bleeding.
- Pregnancy rates in several
studies have been reported to be slightly
increased in the first months following
a hysterosalpingogram. This may be due
to the fact that the flushing of the tubes
with the contrast could open a minor blockage
or clean out some debris that may be a
factor that is preventing the couple from
conceiving. Some of these studies suggest
that using oil based contrast provides
a greater increase in pregnancy rates
after a hysterosalpingogram than does
the use of water based contrast.
Pelvic Ultrasound (Sonogram) Procedure
A pelvic ultrasound uses sound waves to produce images of the inside of your body. There is no radiation.
Ultrasound is helpful in evaluating pregnancy as well as other pelvic conditions.
Before
Your physician's office will schedule this procedure. About 1 hour before the exam, drink a
large quantity of water. Do not void. For the exam to be successful, your bladder must be full.
During
You will be asked to change into a hospital gown. You lie on a special table. An oil or gel will be applied to your skin. A small probe, called a
transducer, will be passed over the surface of your abdomen. When images are made, you will be
asked to remain perfectly still and to control your breathing.
You doctor may need a different view of the pelvic area. A female technologist will place an
instrument probe into your vagina to take the images. The procedure usually lasts less than an hour.
After
A radiologist examines the images made by the ultrasound. The results are reported to your doctor
within 24-48 hours.
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