When other treatments have failed, surgery can provide a long-term solution for stress urinary incontinence.
Your doctor may suggest a procedure called retropubic suspension, in which an artificial mesh strip is placed behind the tube that drains urine from your body (urethra) to support it. Alternatively, you could have an autologous sling or rectus fascial sling made from tissue from your lower belly.
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Artificial urinary sphincter
Stress urinary incontinence is a condition in which urine leaks due to problems with your sphincter, which controls urine flow. It may occur as a result of prostate surgery, childbirth, episiotomy or neurological diseases that affect this muscle.
In some cases, doctors may suggest the use of an artificial urinary sphincter (AUS) to relieve stress incontinence. The AUS works by using fluid to open and close a cuff that wraps around your urethra.
This cuff is constructed of medical grade silicone and attached to a pump unit in the scrotum. The pressure inside of the pump can be adjusted to help control urinary leakage.
Doctors insert the cuff through an incision at either the base of your penis, or in skin behind the scrotum. Once in place, depress a button hidden under your scrotum to activate it.
Once activated, the sphincter will prevent urine from escaping until the bladder has filled again. However, it won’t be ready for use until six weeks after insertion.
Today, there are various AUS devices available on the market. Which one is more effective depends on what type of incontinence the patient has.
The AMS 800 is the most commonly used artificial urinary sphincter in America, having been in use since 1973 and widely regarded as the gold standard for treating male stress urinary incontinence. While this device has an impressive success rate, there can be complications such as urethral atrophy, erosion and infection that need to be taken into consideration before proceeding with its use.
Vaginal mesh
Some women may consider surgery as a last resort when other conservative treatments (like lifestyle changes and pelvic floor exercises) fail. However, surgery is more invasive than other options and carries higher risks of complications.
Vaginal meshes are medical devices used to repair weak or damaged tissue in a woman’s bladder or pelvis. Most are made from synthetic (man-made) material called polypropylene; however, some meshes can also be made from animal tissue.
Mesh is used to strengthen weak areas of the pelvic floor or prevent and treat pelvic organ prolapse (POP). It may also stop urethral leaks.
Mesh is placed atop the vaginal wall and stitched into connective tissues to support it. It may be a thin strip or an expansive square piece that’s attached directly to the vaginal wall for extra support.
Dr. Badlani recommends placing mesh transvaginally for its less invasive nature and lower risks than abdominal or robotic surgery, since there is less potential risk of mesh erosion into the kidney or ureter and bladder stones in some cases. She noted that many doctors prefer this route due to its lower risks and potential benefits for their patients.
Oz Harmanli, MD and chief of Yale Medicine Urogynecology & Pelvic Reconstructive Surgery in New Haven, Connecticut, believes doctors should have the option to use mesh when it’s the best choice for their patients. They should discuss both its advantages and potential drawbacks with them first, then let them decide which option is best suited to them.
Mesh slings have been a well-documented and safe option for women with SUI for years, and many major urologic and gynecologic societies now endorse the use of mesh in midurethral slings based on comprehensive evidence. Organizations such as the SUFU, AUA, AUGS, and ICS have issued statements in favor of mesh use in SUI surgery based on this evidence.
Colposuspension
Stress urinary incontinence is one of the most prevalent types of incontinence among women and can be caused by a variety of factors. More than 10% of women experience this issue, which can be very debilitating. Most often, conservative methods are employed; however, sometimes surgery may be necessary to achieve successful results.
Colposuspension, a surgical solution for stress urinary incontinence, is one of the most popular and successful treatments available. This involves making an incision in your lower stomach (abdomen) and lifting the neck of your bladder before stitching it back in its upright position.
It is a safe procedure with impressive long-term success rates. Over 80% of patients report their incontinence issues resolved or cured after surgery, with around 60% still maintaining continence 20 years later.
Operation can be performed either through a small incision in the abdomen or laparoscopically (through a tiny hole called ‘keyhole’). In either case, the surgeon inserts a camera into an area behind your pubic bone and then sutures together the bladder and urethra.
This treatment for stress urinary incontinence can be highly effective, however it may cause some side effects in certain individuals. This is because it alters the amount of urine you produce and may leave some residual volume after using the bathroom.
Some women experience difficulty emptying their bladder after a colposuspension, though this may improve over time. If this occurs to you, be sure to inform your doctor so they can suggest an alternate treatment option.
The cost of a colposuspension depends on the type of operation you select. Before making any decisions, be sure to discuss all available options with your doctor and get quotes for different surgeries.
Rectus fascial sling
The rectus fascial sling is a surgical treatment for stress urinary incontinence that utilizes the patient’s own tissue. In this operation, an abdominal strip of tissue is taken and wrapped around the bladder neck and urethra; unlike other types of slings like TVT sling which utilize synthetic material or mesh.
Fascia is a layer of strong connective tissue that covers the abdominal muscles. In this procedure, a sling made out of about 1-3cm wide strip of fascia is placed beneath the urethra to provide support and reduce urine leakage.
Women with stress urinary incontinence often opt for a sling in addition to other treatment options, as the majority of women find success with it more effective than other solutions.
After your surgery, you may experience bleeding or vaginal pain and some women may have difficulty passing urine. These symptoms usually take a few weeks to resolve and your doctor can provide guidance on how to effectively pass urine.
If these problems don’t resolve after some time, your surgeon can discuss with you whether to loosen or remove the sling altogether. In about 5% of women, this may cause pain and pressure around their pelvic area or groin.
The rectus fascial sling procedure is an efficient, long-lasting and less invasive alternative to transvaginal sling (TVT) and transobturator tape (TOT) procedures for stress urinary incontinence. It’s simple and straightforward to perform, with a lower risk of complications than TOT or TVT procedures.
Retropubic mesh sling
The retropubic mesh sling is one of the most widely used surgical procedures to treat stress urinary incontinence. This minimally invasive procedure uses synthetic mesh support for your bladder and urethra, and has been well studied for its long-term benefits.
In this surgery, your doctor will create a small hole inside of your vagina and under your urethra. They’ll also make two tiny cuts on your pubic bone that are just large enough to thread a needle through. Finally, they’ll pass a mesh sling behind both of these points – underneath both pubic bones and under urethra.
Mesh slings come in several varieties. Mini slings use the smallest mesh available, while retropubic slings utilize your pubic bone to secure your bladder.
Mesh slings can break down in the vagina, especially if you have thin and delicate vaginal tissue due to low estrogen levels. Usually this isn’t a major issue and can be remedied with either vaginal cream or by cutting away any exposed mesh.
However, in rare instances the mesh can cause painful scar tissue or erosion of the bladder or urethra. If you experience pain after surgery it’s essential that you inform your doctor.
After surgery, you should rest for several days or weeks. Avoid straining or exercising, lifting anything heavy, and engaging in any sexual activities until your doctor approves.
Your recovery timeframe depends on the procedure you had and what materials were used for the sling. Generally, it takes 2-6 weeks for your sling to heal completely and allow you to resume normal activities. You’ll be provided instructions as to when to start exercising again and how much activity is allowed.