Doctors may suggest surgery to improve bladder control if other treatments have failed. Surgery helps only stress urinary incontinence and it has proven to be very effective. The best surgical procedures improve or cure the incontinence associated with coughing laughing sneezing and exercise in about 85% of women. When mixed incontinence or a component of urge incontinence is also present, the surgical success rates for complete bladder control are reduced because these procedures are not designed to treat the urge incontinence component.
Surgical management of urinary incontinence should only be considered after several criteria have been met:
- Incontinence symptoms are bothersome
- Stress Incontinence has been confirmed by your doctor during bladder testing
- Non-surgical treatments have failed to provide relief of symptoms
- The benefits of surgery are expected to be greater than the possible risks.
The most commonly performed incontinence surgeries with the highest success rates are:
(see descriptions below)
- Sling-type Procedures (also called vaginal tape or TVT)
- Burch or Marshall Marchetti Krantz Colposuspension Procedures
- Periurethral Bulking Agent Injections
Sling-type Procedures
Also referred to as the Tension-free Vaginal Tape procedure (TVT). This procedure involves placing a strap of graft material underneath the mid to upper portion of the urethra or neck of the bladder to provide support during activities that increase abdominal pressure such as coughing or lifting something heavy. The support helps to prevent urine from leaking out through the urethra. Over the years, numerous graft materials have been used. Today, the sling is most often made of polypropylene mesh.
The mid-urethral mesh sling is inserted through three small half inch incisions: one in the vagina (underneath the urethra) and two above or alongside the pubic bone. The sling can be placed at the time of another procedure or it can be done independently as an outpatient procedure under minimal anesthesia. The continence rates after the sling are equivalent or slightly superior to the traditional Burch procedure demonstrated in clinical trials.
Burch or Marshall Marchetti Krantz (MMK) Colposupension
Retropubic colposuspensions (either the Burch or MMK procedures) have been performed for over 50 years through a lower abdominal incision. In this operation, stitches are placed into the vagina wall alongside the urethra at the bladder neck and then secured to ligaments nearby in the pelvis (Cooper’s ligament) or into the strong tissue that covers the back of the pubic bone. The stitches lift the vaginal wall that the urethra rests upon and provides support to the bladder neck and urethra. These procedures can also be done laparoscopically. The procedure produces a long-term improvement in more than 70% of patients with stress incontinence.
Peri-urethral Bulking Agent Injections
In this procedure, a long acting or permanent paste-like substance (such as collagen or others) is injected into the muscular wall of the urethra using a
cystoscope
. This injection causes the tube of the urethral to narrow which results in less urine leakage. Although the rate of continence is less after this procedure when compared to the sling type or the Burch procedures, it is much less invasive, does not require incisions, has a low complication rate and can be performed in an office or on an outpatient basis. Seven out of 10 women who have a bulking agent injection report that their leakage is improved or has stopped. This improvement lasted about 1-2 years at which point, if the leakage returns and is disturbing, the same procedure may be repeated or an alternative treatment may be chosen.
Periurethral bulking agent injections are frequently recommended for women
- in poor medical health for whom more invasive surgery or anesthesia is not safe;
- on blood thinner medications;
- cannot take time off to recover from surgery; or
- who continue to leak after other incontinence surgery.
Sources
American Urogynecologic Society
Original publication date: May 2008