What are the surgical methods to treat urinary incontinence?

The placement of a sling can benefit women with urinary incontinence. The success rate of the procedure is 90 to 95 percent.

Surgery for urinary incontinence is generally recommended only after other measures such as pelvic floor exercises or medication have failed to provide enough help. The trend in surgery for incontinence is toward less invasive surgical procedures that can usually be performed on an outpatient basis and sometimes in the physician's office. Because some surgical procedures for stress incontinence (leaking when coughing or jumping) are now relatively quick and require less recovery time, your doctor may recommend surgery earlier if your incontinence is caused by a repairable structural problem or if it seems unlikely that nonsurgical approaches will be satisfactory. When choosing to have a minimally invasive surgery, it is especially important that your surgeon be highly trained and experienced in the specific procedure you choose.

Surgery is usually considered a last resort after all other treatments have been tried for urinary incontinence or overactive bladder (OAB). But in some cases, when incontinence is caused by a bladder that has moved out of place, surgery may be the best option. The most common surgeries for incontinence involve lifting and supporting the bladder—either with sutures, tape, or a sling—closer to its original position.

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Dr. Kevin W. Windom, MD
OBGYN (Obstetrician & Gynecologist)

There are three main types of urinary incontinence: stress urinary incontinence, which is the leakage of urine with coughing, sneezing, and physical activity; urgency incontinence, which is the leakage of urine with severe bladder spasms and unable to make it to the restroom in time; and overflow incontinence; where the patient does not adequately empty her bladder and constantly has a high residual volume of urine after each urination.

Stress incontinence is the most common surgically treated form of incontinence. Over the years there has been numerous different types of surgical procedures, but now, the most common procedure is a "sling procedure." This is a surgery in which a polypropylene mesh is placed underneath the midportion of the urethra, and when the patient coughs, sneezes, or laughs it causes a kinking of the urethra, which helps decrease leakage of urine.

Urgency incontinence and overflow incontinence are usually treated with dietary changes and medications, but occasionally urgency incontinence and overflow incontinence can be treated with a InterStim device. This is a surgical procedure in which an electrical stimulator is placed into the S3 sacral foramina, and it stimulates the nerves to the bladder muscle helping to relax the muscle and decrease the bladder spasms. It has also been shown in numerous studies that this surgery can help with patients who are unable to adequately empty their bladder and end up having overflow incontinence. Lastly, there is a small subset of patients (usually elderly patients) who have nerve damage to their urethra in which their urethra is always open, and these people can be treated with a surgical procedure in which collagen or other types of bulking material are injected around the urethra to help tighten the urethra and help decrease the leakage of urine.

There are several types of sling procedures. In this video, watch as I perform a transobturator tape sling procedure. (Note, this video is not for the faint of heart.)

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.