There are several surgical procedures for the various types of incontinence. These procedures are reserved for people who have tried conservative treatments without success and are healthy enough to undergo surgery.
When the bladder or urethra has fallen out of place, retropubic suspension is used to attach the tissue next to the bladder or urethra to the pelvis (bringing the bladder or urethra back to the correct position). The procedure is called Marshall-Marchetti when the vaginal tissue is attached to the back of the pubic bone. It is called a Burch procedure when the vaginal tissue is attached to the side of the pelvis. These procedures can also be done laparoscopically, which requires smaller surgical incisions.
The doctor attaches a piece of tough, tendon-like material called fascia around the bladder neck to keep urine from leaking out. Two incisions are made—one through the vagina and one through the abdomen.
When the urethra has fallen out of position or when the sphincter muscle of the urethra is weak, this procedure is used to place a sling under the urethra. The sling can be made from natural tissue or from man-made material. It acts as a hammock to support the neck of the bladder (where the urethra enters the bladder) and to prevent leaks. Some slings are attached to the pubic bone by stitches, while others are tied in front of the abdomen above the pubic bone. Sling procedures are done through small incisions in the vagina and abdomen.
Newer, less invasive suburethral sling procedures include tension-free vaginal tape (TVT) and transobturator tape (TOT). TVT is a mesh that is placed around the middle of the urethra. One small incision is made in the vagina, and two small incisions are made in the abdomen. TOT is a similar procedure that involves one small incision through the vagina under the urethra and one small incision in each thigh.
The doctor places a strip of material under the urethra to provide support and to prevent the urethra from opening spontaneously. The ends of the strip are attached to the pelvic bone
The procedure helps men who have persistent severe leakage, often after prostate surgery as a result of nerve damage, or because of weak sphincter muscles. An artificial sphincter is a device that keeps the urethra closed until it is time to urinate. A soft cuff is placed around the urethra to gently squeeze the urethra closed. A small pump is placed in the scrotum, which can be squeezed manually through the skin, transferring fluid from the cuff into a small balloon reservoir in the abdomen. This allows urination to take place as the urine can then flow through the urethra.
This procedure reduces urge incontinence. Surgery is done to place a thin lead wire with a small electrode tip in the lower spine near the sacral nerve. A nerve stimulator continuously sends electronic impulses to the sacral nerve. This electronic stimulation therapy creates a bladder pacemaker, which reduces or eliminates urge incontinence.
When the sphincter muscle of the urethra is very weak, a substance called "bulking material" is injected into the tissues around the urethra. This causes the sphincter to become more narrow, and thus resistance to urine leakage increases. Bulking material is either organic collagen (a natural protein found in the body) or a man-made substance composed of small, carbon-coated, zirconium beads. This is a noninvasive surgical procedure that involves an injection.
When the bladder is too small to hold the normal amount of urine produced by the kidneys, bladder augmentation can increase the size of the bladder and also its ability to stretch. A portion of the intestines or the stomach is attached to the bladder. General anesthesia is necessary, as a large incision is made in the abdomen. This surgery can also be done laparoscopically . Oftentimes, patients will need to use a catheter after the surgery to drain urine from the body.
Culligan PJ, Heit M. Urinary incontinence in women: evaluation and management. Am Fam Physician. 2000;62(11):2433-2444.
Frick AC, Paraiso MF. Laparoscopic management of incontinence and pelvic organ prolapse. Clin Obstet Gynecol. 2009;52(3):390-400.
Surgery for stress urinary incontinence. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/Patients/FAQs/Surgery-for-Stress-Urinary-Incontinence. Updated July 2014. Accessed May 19, 2017.
Urinary incontinence. National Association for Continence website. Available at: https://www.nafc.org/urinary-incontinence. Accessed May 19, 2017.
Urinary incontinence in men. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T900624/Urinary-incontinence-in-men. Updated December 13, 2016. Accessed May 17, 2017.
Urinary incontinence in women. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T900573/Urinary-incontinence-in-women. Updated May 15, 2017. Accessed May 19, 2017
Last reviewed May 2017 by Adrienne Carmack, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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