Surgery For Urinary Incontinence

Surgery can help improve urinary incontinence. Surgery should be considered only if conservative treatment fails to improve your incontinence. If surgery is an option for you, find a doctor that is skilled and experienced with this condition. Since there are many types of surgical procedures to treat incontinence, make sure to discuss all your options and expectations with your doctor.

Bladder Repositioning

Bladder repositioning is a common surgery to correct urinary incontinence in women. When the bladder drops down toward the vagina it can cause stress incontinence. Stress incontinence is when urine leaks from the bladder with activities such as a cough, laugh, sneeze, or with physical exertion (lifting or running). This is usually caused by weak or overstretched pelvic floor muscles that support the bladder. Multiple pregnancies, childbirth, and abdominal surgeries can cause the pelvic floor muscles to become over flexible and weak. The bladder can drop down toward the vagina and leak urine when there is any abdominal exertion. With bladder repositioning, the pelvic floor muscles are reinforced and the bladder, uterus and other tissues are placed back into their proper position in the body.

Sling Procedure

There are many types of sling procedures to correct incontinence. This type of surgery may be an option for severe cases of stress incontinence in women that have specific reasons for thier incontinence. This is for moderate to severe incontinence. It can also be indicated for men with incontinence following prostate surgery. It is a fairly successful procedure, but does have some post op complicatons such as urinary tract infection, difficulty voiding or urge incontinence in a very small number of women.

Retropubic Colposuspension

This is an effective option for severe stress incontinence that requires a long term solution. It is a large incision procedure with a cure rate of 80-90%. This procedure corrects the position of the bladder and urethra by attaching them to the surrounding bone and supportive tissue. It is a good option for women who have a too much mobility or an overstretched urethra ( tube that brings urine outside of the body). This surgery utilizes a general or spinal asthetic and generally requires a 2 day hospital stay.

Burch Colposuspension

This is a common procedure to correct severe bladder or uterine prolapse into the vagina. It uses a wide abdominal incision and is often performed during hysterectomies and hernia operations. The surgeon suspends and stabilizes the urethra and base of the bladder with sideway sutures that attach into the thick bands of muscle that connect to the pelvic bone. There is less risk of complications of urethral obstruction with this procedure versus a sling procedure. It is more successful in premenopausal women versus postmenopausal women. Urinary tract infections are one of the post operative complications that may occur.

Needle Suspension

This type of surgery places stitches on both sides of the bladder and ties them to the surrounding muscle and bone. This helps keep the bladder from lowering down into the vaginal area.

Transurethral Resection of the Prostate (TURP)

This procedure us the standard treatment for males with severe benign prostatic hyperplasia. Stress incontinence can occur following this surgery in approximately 5% of men. These men will need to perform exercises to improve any weakness of the pelvic floor that was caused by the surgery.

Marshall-Marchetti-Krantz Proxedure

This procedure involves a wide abdominal procedure followed by elevation of the urethra and bladder using sutures. The sutures anchor the bladder and urethra to surrounding cartilage. It is very reliable and successful, although risks of scarring are greater. The surgeon is usually not able to correct any hernias or cystoceles during this type of procedure.

Radical Prostatectomy

Surgical removal of the prostate gland to treat prostate cancer is known as a radical prostatectomy. Incontinence is common for the first 3-6 months after this type of procedure. After one year, most men have full return of normal urinary function. If mild leakage still occurs, it is most likely due to stress incontinence from weakness.

Artificial Sphincter

Some men may have success with the surgical implantation of an artificial sphincter. This is a device that keeps the urethra closed until you are ready to urinate. This is indicated for men who have nerve damage affecting the sphincter muscle function. It does NOT help men who have over active bladder or urge incontinence. A cuff is placed around the urethra, a small bladder is placed in the abdomen and a pump is placed in the scrotum. When it is time to urinate, you squeeze your scrotum to activate the pump that deflates the cuff around the urethra. When you empty your bladder , the cuff automatically resets and closes off the urethra again.

Catheterization

A catheter is a tube that is inserted into the urethra and bladder to help drain urine from the bladder. It can be used on a short term basis, such as after a surgical procedure. It can be used to help fully empty the bladder for people who have neurological damage causing the bladder to hold onto urine. People can be taught how to catheterize themselves if it needs to be done often. Some catheters can be left in for longer periods of time, but there is a risk of urinary tract infections with long term use.

Botox

Botulinum, or Botox, is a toxin that is a very powerful muscle relaxant. Botox is currently being researched to see if it may help relax muscles and help stop incontinence in people who have overactive bladder or urge incontinence.

Hysterectomy

There is a decrease in incontinence in women who have a hysterectomy. A hysterectomy should not be performed to cure incontinence. A hysterectomy is only performed for other medical diagnoses. If a women requires a hysterectomy for a medical reason, it may decrease symptoms of incontinence.