If you are suffering from stress urinary incontinence, surgery may be an option to address the condition. These procedures have proven successful for around 85% of women experiencing incontinence issues.
This procedure utilizes a strip of synthetic mesh to support your urethra at the bladder neck and help prevent leaks.
Artificial urinary sphincter
An artificial urinary sphincter (UAS) is an implanted device designed to replace the natural urethral valve and prevent urinary leakage, helping men suffering from severe stress urinary incontinence to avoid further leakage of urine. AUAs may also be used as a last resort treatment option in cases that have failed other approaches.
System components include a cuff placed around the urethra and connected to a pump in your scrotum. When you need to urinate, activate the pump and squeeze down on the cuff by hand – when finished urinating automatically re-inflates back.
After surgery, you will likely remain hospitalized for several days to two weeks for recovery from your procedure. Extended stays may be necessary if there are issues in the wound area or infections are present that necessitate treatment.
Surgery to place an artificial urinary sphincter has long been considered the treatment of choice for stress urinary incontinence since 1972* and is generally suitable for most patients suffering moderate to severe incontinence. Furthermore, this surgery may also benefit those who have undergone prostate surgery or experienced damage from radiation therapy for prostate cancer treatment.
If you suffer from mild to severe stress urinary incontinence, your doctor may suggest conservative measures like restricting fluid intake or performing pelvic floor exercises as first steps in treating it. If these don’t work effectively, he might suggest medications or surgery as possible solutions.
Artificial urinary sphincter devices come in many shapes and sizes. One such product, manufactured by American Medical Systems is known as AUS 800.
Flow-Secure is another device designed for abdominal implant. This one involves making a small incision in the groin for placement of its components – including its cuff, pressure regulating balloon and pump that connects directly to it.
When the need arises to urinate, simply squeeze the pump to transfer fluid from your cuff to the balloon. As soon as your cuff is empty, urethra opens up for easy urination; any excess from balloon recirculates back into cuff and automatically reinflates.
AUS has proven itself effective at treating stress urinary incontinence following radical prostatectomy for prostate cancer and represents an attractive option for treating this condition in men. With high patient satisfaction rates and the most efficient outcomes after prostate surgery, AUS remains a top treatment choice.
Vaginal mesh
Vaginal mesh implants are used to reinforce weak areas in the vagina and bladder. It may support dropped organs or prevent urine leakage in women suffering from pelvic organ prolapse (POP) and stress urinary incontinence (SUI).
Mesh insertion is one of the most frequently performed surgical treatments for POP and SUI, typically through vaginal placement of plastic mesh to repair damaged pelvic walls or support bladder neck and urethra structures. Different kinds of mesh may be utilized; typically either polypropylene or animal tissue-based products.
Mini slings are one of the newest procedures, employing tiny mesh that requires only a single vaginal incision and can be performed under either general or spinal anesthesia. Retropubic sling procedures use pubic bone to guide their mesh in place; this method has an increased risk of puncturing bladder walls during surgery, though injuries usually heal quickly if treated promptly afterward.
Some women may experience side effects from using mesh, including vaginal infection or bleeding, which requires surgery to be removed. If this becomes serious enough, further action may need to be taken such as surgical removal of the mesh.
Other complications may arise when implanting mesh into other parts of the body, including the urethra or bladder, leading to erosion or irritation, pain or tightness in vaginal areas and even tightness within.
As time progresses, mesh may loosen from its adhesions in the vagina and begin to break off, become exposed or erode through. These complications may cause symptoms as well as hamper normal activities and life.
These issues can be especially concerning because they tend to affect women who have undergone multiple surgeries and who may be susceptible to infections and medical conditions. Furthermore, removing mesh without prior treatment could prove harmful.
Surgery to remove mesh may create complications for both your vaginal wall and ovaries, leading to difficulty managing vaginal discharge or leaks that become difficult to manage.
Mesh can cause several complications during surgery to repair pelvic organ prolapse or stress urinary incontinence, with vaginal leakage being the most prominent one. Other issues can arise including erosion of mesh into other parts of your body such as the urethra, bladder or rectum causing discharge or leakage.
Colposuspension
Colposuspension is a surgical solution to stress urinary incontinence that involves lifting your bladder neck (the part connecting it with the urethra). This operation may be performed under either general anaesthesia or spinal anaesthesia for maximum comfort and results in lasting relief of symptoms.
A bikini line cut will typically be performed on your abdomen, followed by sutures being attached either side of your bladder neck in your vagina and attached to a ligament at the back of your pubic bone via ligament ties or sutures which either dissolve slowly over time, providing extra support to your bladder neck area.
This surgery boasts a success rate of approximately 85% in treating or significantly improving stress urinary incontinence issues. Although not a panacea for every form of incontinence, this surgery has proven helpful for most women who do not respond to other forms of therapy.
Other ways of treating stress urinary incontinence include pelvic floor physiotherapy and botulinum toxin A injections into the sides of the bladder – typically used to address overactive bladder and urge incontinence issues.
Retropubic suspension surgery is another potential solution; though less popular nowadays, it involves using mesh. Unfortunately, it involves longer procedures with an increased risk of scarring.
Mesh is secured to the urethra and bladder neck using two sutures on either side of the urethra and Cooper’s ligament, with the most distal one situated lateral to the proximal third of the urethra, and two cm lateral to bladder wall at level of urethrovesical junction.
Some women may experience difficulty emptying their bladder after having undergone colonoscopy or colposuspension; this is typically temporary and improves over time. Other women may have chronic urinary tract infections which keep reappearing.
Your doctor can give you more details on which treatment will best meet your needs, as well as what can be expected after surgery. Antibiotics may be necessary in order to prevent infection after the operation; you will also need to learn how to clean yourself properly in the aftermath of this treatment.
After an operation, it’s best to avoid smoking, couging and exercise as this will only make recovery more challenging for your body. Your physician will inform you when it is safe for you to drive and return to work.
Sling surgery
Stress urinary incontinence occurs when urine leaks out from the urethra due to weakness or prolapse of bladder or sphincter muscles, affecting about one third of women at some point during their lives and becoming both annoying and debilitating. It affects about 1 out of every 3 women.
Surgery may help alleviate symptoms and facilitate independent bathroom usage. Your physician will discuss all available options and help determine what would work best for you.
Sling surgery is a type of pelvic floor surgery in which a sling is used to support and stop your urethra or bladder neck from leaking urine, providing less-invasive alternatives to artificial urinary sphincter devices and can even be done in-office.
Your doctor may suggest a pubovaginal sling to you if you suffer from moderate to severe stress urinary incontinence. This procedure uses a small strip of tissue from within your own body to support and protect the urethra against leakage.
Your surgeon will make a small incision between your scrotum and anus to place a sling around part of the male urethra bulb to compress and lift it, thus preventing leaks.
There are various kinds of slings, each tailored specifically to meet a particular purpose. While some are made from synthetic mesh material, others utilize strips from your own tissue or donor tissues for support.
Some sling procedures employ a scope to allow the surgeon to view inside your bladder and urethra during the procedure, and can help them identify areas such as bleeding, holes in your urethra or where the sling has been placed. This helps them check for bleeding or holes while making an accurate placement assessment for their sling sleeve sling.
Surgical slings may be beneficial if you’re experiencing moderate to severe stress urinary sphincter problems that are not improving with Kegel exercises or behavioral treatments, like behavioral therapy or Kegels. They can also help when treating mixed incontinence (a combination of stress urinary sphincter incontinence and urgency urinary incontinence), which is more difficult to manage with traditional methods of therapy.
Sling surgeries are usually outpatient procedures that allow patients to return home the same day. After surgery, it’s essential that patients rest for several days post-op before engaging in sexual relations and until their urethra heals fully.
