Doctors may suggest surgery to improve bladder control if other treatments for incontinence have failed.
Surgery helps stress urinary incontinence. The best surgical procedures improve or cure the incontinence associated with coughing, laughing, sneezing, and exercise in about 85% of women. However, the success rate for mixed incontinence, a combination of stress and urge incontinence, is lower. The reason is that current surgical procedures are not designed to treat the urge incontinence component.
Experts recommend you consider surgery for urinary incontinence only if:
- Incontinence symptoms are bothersome.
- Your doctor confirmed the diagnosis of stress incontinence using bladder testing.
- Non-surgical treatments for incontinence failed to provide relief of symptoms.
- The benefits of surgery are expected to be greater than the possible risks.
Talk with your doctor about the benefits, risks, after-care requirements, and long-term considerations of surgery. You may also want to seek a second opinion from a pelvic floor disorder expert such as an urogyn. Find a urogynecologist in your area.
Types of Stress Urinary Incontinence Surgery
The most commonly performed incontinence surgeries with the highest success rates are:
- Mid-urethral Mesh Slings (also called Vaginal Tape, TVT, TOT, Transobturator Slings, Mini-Slings)
- Pubovaginal/Fascial Bladder Neck Slings
- Burch or Marshall Marchetti Krantz Colposuspension Procedures
- Urethral Bulking Agent Injections.
Mid-Urethral Mesh Slings
Mid-urethral sling procedures are the most commonly performed SUI operation. They are safe, effective, and improve quality of life for many women. These procedures involve placing a thin piece of mesh underneath the middle part of the urethra (mid-urethra) to provide support. The graft material in this type of sling is most often made of polypropylene mesh. These procedures have been done for over 20 years with excellent results. There are three types of mid urethral slings:
- Retropubic sling: The sling sits just under the mid-urethra and exits just above the pubic bone with an incision on each side. It is also called tension free vaginal tape procedure, or TVT™, or another name depending upon the company who makes the product.
- Transobturator sling: The sling and exits on each side of the groin through two small incisions. It may also be referred to as a TOT™ or Monarc™ or have another name depending upon the company who makes the product.
- Mini-Slings (Single Incision Slings): The sling requires only one incision in the vagina and self-anchors. It may also be called a MiniArc™ or have another name depending upon the company who makes the product.
Mid-urethral slings are the best-studied incontinence surgery in history. The Food and Drug Administration (FDA) supports the safety and effectiveness of this surgery. The permanent mesh used in this surgery does not cause the high rates of complications that have been in the news related to mesh used for other types of vaginal surgery.
Pubovaginal/Fascial Bladder Neck Slings
Physicians have been performing this operation for stress urinary incontinence since 1947. In this operation, the surgeon uses strong tissue called fascia underneath the urethra with the ends sutured to the tissue covering the abdominal muscles. There is a small incision in the vagina and another just above the pubic bone with this procedure.
This procedure is called a bladder neck sling because the tissue is placed at the level where the urethra meets the bladder. The tissue can come from the patient herself or from donated tissue. This procedure does not utilize mesh.
Burch or Marshall Marchetti Krantz (MMK) Colposupension
In retropubic colposuspensions (either the Burch or MMK procedures), the surgeon places stitches into the vaginal 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.
This procedure is done very infrequently and does not utilize mesh.
Urethral Bulking Agent
In this procedure, a long acting or permanent paste-like substance 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 other surgeries for stress urinary incontinence (SUI), this procedure:
- 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.
Doctors frequently recommend this procedure for women in poor health, for whom more invasive surgery or anesthesia is not safe; in women with intrinsic sphincteric deficiency; or for those women who continue to leak after other incontinence surgery.
Urethral bulking agents include:
- Autologous fat
- Calcium hydroxylapatite (Coaptite)
- Carbon beads (Durasphere)
- Polydimethylsiloxane (Macroplastique).