Women suffering from urinary stress incontinence often experience leakage of urine while coughing, sneezing, laughing and exercising. Surgery typically improves or cures this condition in approximately 85% of women.
These surgeries offer an effective solution for weak bladder muscles. By placing a sling of body tissue around the urethra and bladder neck to provide support for them, they aim at strengthening these areas.
Midurethral Sling
Stress urinary incontinence (SUI) is a condition in which urine leaks out uncontrollably when exercising, coughing or sneezing – significantly diminishing quality of life. Non-surgical solutions like weight loss, Kegel exercises and pelvic floor physical therapy may be helpful, while surgical options may be an option if symptoms continue.
Sling surgery is the go-to treatment option for stress incontinence. Through this procedure, surgeons create a hammock-like device made out of either your own tissue or synthetic mesh to support your urethra and bladder neck (where the urethra connects with bladder) better resist pressure from physical activities like laughing, lifting and coughing. There are different types of sling procedures, and your doctor will help select which is most appropriate for you.
Your doctor will make a small incision in your vagina to access and position the urethra and insert a sling. At this time, he or she will also conduct cystoscopy examination of your bladder for damage from surgery (cystoscope).
Retropubic or transobturator surgery involves making a small incision at the back of your vagina to insert a sling, followed by two small incisions in your groin for each end to pass through and finally be stitched shut with skin closures. Your physician will choose an incision method depending on your anatomy and disease state.
A mini-sling is similar to its larger counterparts but uses shorter strips of mesh with self-fixing anchors, making this method less invasive but its results less strong and reliable; therefore it should only be recommended for people suffering severe incontinence. Graft slings use fascia from your abdomen or thigh as support to support the urethra; although similar, this approach doesn’t offer as much strength or reliability and should never be used to treat prolapse.
Retropubic Suspension
If behavior modification and pelvic floor exercises aren’t helping your stress urinary incontinence symptoms, surgery could be your answer. NYU Langone’s Center for Female Pelvic Medicine may suggest retropubic suspension surgery as an effective solution – your surgeon makes an incision in the lower part of your abdomen before placing stitches through tissue near the vagina to support and secure both bladder and urethra into place; furthermore it keeps the urethra closed so as to reduce leakage of urine from its pathway into which leakage could enters the system preventing leakage of urine from leaving its home environment.
Before your surgery starts, either general anesthesia or spinal anesthesia will be administered to ensure complete comfort throughout. With general anesthesia, you’ll sleep through it and experience no pain; with spinal anesthesia you will remain conscious but numb below the waist down. A catheter (tube) will then be inserted to drain any urine out of your bladder.
The bladder neck is where your urethra connects with the rest of your bladder. Sometimes after childbirth or having a urinary tract infection, its position can shift out of its usual range; surgeons have developed techniques such as retropubic suspension and two types of sling procedures to return it back into its usual place.
Burch colposuspension is one type of sling procedure. Your surgeon attaches one end of surgical threads to the outer wall of your vagina, and another end to ligaments near the top of your pelvic bone; when tightened, these sutures effectively suspend your walls of vagina from below and shift them up towards supporting the urethra from beneath.
Tension-free vaginal tape (TVT) sling procedures offer another form of support to pelvic tissues, using mesh tape as an additional form of support. Studies have proven it equally effective as retropubic suspension and laparoscopic sling procedures in treating stress urinary incontinence while attributing significantly lower morbidity rates than traditional methods.
Burch Colposuspension
Burch colposuspension is an effective abdominal operation to treat female stress urinary incontinence caused by loose and hypermobile bladder neck muscles. The procedure works by lifting the bladder neck up onto strong ligaments on pelvic bones with sutures, helping prevent uncontrollable urine release during urination as well as uncontrollable activities like laughing, coughing or jumping that lead to involuntary urine release.
The surgeon accesses the retropubic space, also known as “Retzius’ space,” using either a Pfannenstiel or Cherney incision. They will then make cuts near to the pubic bone to reveal the urethra while taking care not to dissect in its midline.
Study results compared the effects of laparoscopic Burch colposuspension with retropubic midurethral sling for women who failed to respond to conservative treatments, and had urodynamically proven SUI. Overall success among both groups was similar after 12 months; however, at 24 months Kaplan-Meier curves showed significantly greater rates of successful SUI outcomes specifically within the sling group (P=0.001).
There have been various less invasive surgical approaches developed to address severe and refractory stress incontinence. These approaches include mid-urethral tape slings and autologous slings. Although these approaches are less invasive than Burch colposuspension, they don’t provide as much support to the bladder neck and urethra.
Burch colposuspension surgery boasts a high success rate with limited risks and minimal blood loss, restoring normal anatomic relations between bladder and urethra and improving pressure transmission to the urethra to treat SUI more effectively.
Dr. Margolis is widely recognized for her expertise in performing laparoscopic variants of this operation. For years she has performed this procedure successfully with excellent long-term clinical and urodynamic results. When medical comorbidities prevent more invasive surgeries from being undertaken, Dr. Margolis often resorts to laparoscopic autologous or organic sling placement to assist support of bladder neck.
Reach out to our office for more information about the variety of stress incontinence surgical treatment options that are available, and together we will devise a custom plan designed to bring relief from your symptoms.
Male Urethral Sling
Male urethral slings can help men who experience severe stress urinary incontinence (requiring four or more pads daily) overcome it by implanting a small cuff that takes the place of their sphincter muscle, with tubes connecting it to pressure-regulating balloons in their lower pelvic region and pumps in their scrotums – patients often achieve significant improvement with this surgery and even become completely dry after having this surgery.
The male urethral sling can quickly and painlessly treat stress urinary incontinence by creating a synthetic mesh sling around your bladder neck that’s then stitched to your pelvic wall. This sling provides support to muscles while pulling the bladder neck back toward its original position – relieving pressure off of sphincter muscles. In comparison to some other surgical treatments for stress urinary incontinence, male urethral sling procedures can usually be completed quickly as an outpatient procedure.
After having the sling placed, it is essential that you rest and avoid strenuous exercise until the scar tissue heals. Some men may need to wear a support belt in order to secure their sling in place; those having this procedure should also avoid squatting or climbing ladders as this can loosen it further.
Your surgeon may perform this surgery either through an open incision or several smaller incisions (laparoscopic). Laparoscopic procedures typically have faster recoveries times. You will likely experience swelling and bruising to your scrotum during sling placement; intermittent self-catheterization with catheter will likely need to occur postoperatively for several days post-surgery as you observe signs of urinary obstruction to notify your physician as soon as possible.
Honest communication between you and your doctor about the severity and frequency of stress urinary incontinence is important in finding effective treatments. Giving more detailed information will allow them to select surgery as a more likely remedy.
