Stress urinary incontinence (SUI) is the most common form of urinary leakage. It occurs during activities like coughing, sneezing, laughing, or exercising.
Surgery can be helpful for women with severe SUI that interferes with daily life. But think about your plans for childbearing, as the physical strain of pregnancy and delivery can undo the benefits of a surgical fix.
Abdominal Colposuspension
Abdominal colposuspension is one of the more common surgeries for women with stress urinary incontinence. It involves opening up the abdomen and lifting the bladder neck upwards by stitching it to a ligament behind the pubic bone.
This lifts the urethra and bladder neck so that they are more supported, helping to prevent leakage. It also improves the pressure transmission between the bladder and urethra.
It is usually done using an abdominal incision, but can also be laparoscopically (keyhole). After the operation, a catheter is left in to drain urine.
Patients should not have sex, exercise, or lift heavy objects for at least six to eight weeks after surgery. This is to allow the bladder neck to scar in position and maximise the chances of the procedure working well.
An abdominal sacrocolpopexy for prolapse often improves postoperative symptoms of stress incontinence. However, it is possible that the urethral sphincter muscles become weak after abdominal sacrocolpopexy.
Rectus Fascia Sling
A rectus fasciscia sling is a mesh-free alternative to synthetic mid-urethral slings such as TVT slings, and provides an effective option for women who are unsatisfied with the success rates of these procedures. This procedure combines the strengths of the sling with the advantages of using the patient’s own tissue, and carries a lower risk of complications.
A strip of rectus fascia is removed from the lower abdomen (tummy) and placed around the bladder neck and urethra as a sling. This is a less common procedure than synthetic slings, but is still an effective treatment in the right woman.
The sling group had lower rates of voiding dysfunction than the Burch group at hospital discharge and 6 weeks after surgery. This difference persisted at 24 months. The sling group also had significantly higher success rates specific to stress incontinence than the Burch group, by Kaplan-Meier curve analysis.
Retropubic Mesh Sling
If lifestyle changes don’t help with your stress urinary incontinence, surgery might be an option. Doctors can perform a sling procedure that helps stop or lessen leaks by placing a thin piece of mesh under your urethra, the tube that carries urine out of your body.
The sling can be made from human tissue or synthetic material. Your surgeon will make a cut in your vagina and then put the sling through it.
Mesh sling procedures have been used to treat stress urinary incontinence for over 15 years. However, there is some debate about their safety and effectiveness. There is also a lack of good comparative data on the long-term outcomes of these procedures.
Vaginal Colposuspension
Stress urinary incontinence occurs when the urethra leaks urine during exercise, coughing, sneezing and other activities. Surgery can help reduce or prevent this symptom and may be recommended when conservative measures have failed.
Colposuspension is one of the most commonly performed surgical procedures to treat stress urinary incontinence. It involves placing sutures in the vagina on either side of the urethra and tying them to supportive ligaments to elevate the vagina and support the bladder neck.
Laparoscopic (keyhole) Colposuspension is a less invasive procedure than open Colposuspension. It offers a similar long-term success rate but involves smaller incisions, short hospital stays and faster healing.
Vaginal Colposuspension has been used for more than half a century to treat stress urinary incontinence and is often performed with other pelvic reconstructive surgeries such as hysterectomy, rectus abdominis muscle repair and bladder suspension. However, it is important that the operation is only performed by surgeons experienced in the field and working in a multidisciplinary team.
