20352 Health Library | Health and Wellness | Wellmont Health System
  • Surgical Procedures for Urinary Incontinence

    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.

    Procedures for Female Stress Urinary Incontinence

    Retropubic Suspension
    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.
    Pubovaginal Fascial Sling
    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.
    Suburethral Sling
    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 Procedures
    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.

    Procedures for Male Urinary Incontinence

    Male Sling
    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
    Artificial Sphincter
    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.

    Sacral Nerve Stimulation

    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.

    Bulking Injections

    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.

    Bladder Augmentation

    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.

    References

    Beers MH. The Merck Manual of Diagnosis and Therapy. 17th ed. Whitehouse Station, NJ: Merck Co; 1999.

    Culligan PJ, Heit M. Urinary incontinence in women: evaluation and management. Am Fam Physician. 2000;62(11).

    Frick AC, Paraiso MF. Laparoscopic management of incontinence and pelvic organ prolapse. Clin Obstet Gynecol. 2009;52(3):390-400.

    Incontinence (loss of bladder control). National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/KUDiseases/topics/incontinence.aspx . Updated September 9, 2010. Accessed September 6, 2011.

    Surgical management of urinary incontinence. American Foundation for Urologic Disease website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=06&topic=133 . Accessed August 7, 2010.

    Surgery for stress urinary incontinence. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/publications/patient%5Feducation/bp166.cfm . Updated 2010. Accessed September 6, 2011.

    Surgery for stress incontinence: information for you. Royal College of Obstetricians and Gynaecologists website. Available at: http://www.rcog.org.uk/womens-health/clinical-guidance/surgery-stress-incontinence-information-you . Updated January 2, 2005. Accessed September 6, 2011.

    Urinary incontinence. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/urinary-incontinence/DS00404 . Updated June 25, 2011. Accessed September 6, 2011.

    Way L. Current Surgical Diagnosis and Treatment. 10th ed. Appleton & Lange; 1996.

    What is incontinence? National Association for Continence website. Available at: http://www.nafc.org/bladder-bowel-health/ . Accessed September 6, 2011.

    Revision Information

  • Join WellZones today.

    Make a Change For LifeLearn more

    Wellmont LiveWell is creating a new tradition of wellness in the mountains by providing individuals with tools and encouragement to live healthier lifestyles.

  • HeartSHAPE Spotlight

    At risk for a heart attack? Learn more

    Fight heart disease early and prevent heart attacks with HeartSHAPE® - a painless, non-invasive test that takes pictures of your heart to scan for early-stage coronary disease.

  • Calories and Energy Needs

    Calorie NeedsLearn more

    How many calories do you need to eat each day to maintain your weight and fuel your physical activity? Enter a few of your stats into this calculator to find out.

  • Ideal Body Weight

    Ideal Body WeightLearn more

    Using body mass index as a reference, this calculator determines your ideal body weight range. All you need to do is enter your height.

  • Body Mass Index

    Body Mass IndexLearn more

    This tool considers your height and weight to assess your weight status.


  • Can we help answer your questions?

    Wellmont Nurse Connection is your resource for valuable health information any time, 24 hours a day, seven days a week. Speak to a Nurse any time, day or night, at (423) 723-6877 or toll-free at 1-877-230-NURSE.