Surgical Procedures for Urinary Incontinence
by Michael Jubinville, MPH
Surgery can be used to treat urinary incontinence. It's mainly used if other methods haven't worked. What's needed will depend on the problems you're having.
Surgery for Stress Urinary Incontinence in Women
When the bladder or urethra has fallen out of place, a retropubic suspension can be done. This will put the structures back in place. Vaginal tissue is attached to the back of the pubic bone or to the side of the pelvis. These can be done as open or laparoscopic. Laparoscopic surgery uses smaller cuts and has a faster healing time.
Pubovaginal Fascial Sling
Fascia is a tough, tendon-like tissue that’s attached around the bladder neck. This keeps urine from leaking out. Two cuts are made. One is through the vagina and the other through the belly.
A sling is placed under the urethra to add support. This is done if it's fallen out of place or the sphincter muscle is weak. The sling can be made from natural tissue or be man-made. The hammock-like support at the bladder neck will help stop leaks. The tissue can be attached to the pubic bone or above it in the front of the belly. Small cuts in the vagina and belly are needed to do this.
Suburethral slings use a mesh support placed around the middle of the urethra. They're called tension-free vaginal tape (TVT) or transobturator tape (TOT). TVT uses small cuts in the vagina and belly. TOT uses small cuts through the vagina under the urethra, and one in each thigh. These methods are less harmful to the body and result in faster healing.
Procedures for Urinary Incontinence in Men
A strip of material is placed under the urethra. This adds support and keeps the urethra from opening without control. The ends of the strip are attached to the pelvic bone
This is done for men who have lasting, severe leakage. This can happen after prostate surgery, which can lead to nerve damage or weak sphincter muscles. A man-made sphincter keeps the urethra closed until it's time to pass urine. A soft cuff is placed around it to gently squeeze it closed. A small pump is placed in the scrotum. It can be squeezed by hand through the skin. Doing so will move fluid from the cuff into a small balloon reservoir in the belly. This lets the urine flow through the urethra.
Procedures for Men and Women
Sacral Nerve Stimulation
This is used to treat urge incontinence. A thin lead wire with a small electrode tip is placed in the lower spine near the sacral nerve. A nerve stimulator sends electronic signals to the sacral nerve. This makes a bladder pacemaker to reduce or stop urges.
Bulking material is placed into the tissues around sphincter muscles of the urethra. This makes the sphincter thinner to ease urine leakage problems. Bulking material is made of small, carbon-coated, zirconium beads. They can be made from natural tissue or be man-made.
Bladder augmentation makes the bladder size bigger. It also allows it to stretch. This is useful if the bladder is too small to hold a normal amount of urine. A part of the intestines or stomach is attached to the bladder. This can be done as open or laparoscopic. After, a catheter is used to help drain urine from the body.
Frick AC, Paraiso MF. Laparoscopic management of incontinence and pelvic organ prolapse. Clin Obstet Gynecol. 2009;52(3):390-400.
Procedures. National Association for Continence website. Available at: https://www.nafc.org/procedures. Accessed January 24, 2019.
Surgery for stress urinary incontinence. The American College of Obstetricians and Gynecologists website. Available at: https://www.acog.org/Patients/FAQs/Surgery-for-Stress-Urinary-Incontinence. Updated July 2017. Accessed January 24, 2019.
Treatments for bladder control problems (urinary incontinence). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/treatment. Updated June 2018. Accessed January 24, 2019.
Last reviewed December 2018 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 1/24/2019
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