Stress Incontinence Surgery: What are the Options?

Stress incontinence surgery is a rapidly changing field. With constant advances, surgical methods are becoming much more effective.

Surgery acts as an effective and fast procedure in treating incontinence. However, you should never jump straight into the option of surgery. The initial management of stress incontinence is usually conservative and consists of behavioural and lifestyle modification programs. Surgery is ideal if these methods have shown to be ineffective or if you want to avoid long-term nonsurgical treatment. Harvey Winkler, MD, co-chief of urogynecology and director of female pelvic medicine asserts “everyone needs to make their own decision about surgery.” He explains that surgery is the best approach “if you’re looking for the one-shot deal that’s going to give you the best dryness option.”

The minimum assessment of stress incontinence before surgery is the following:

- Symptoms questionnaire

- Quality of life and impact questionnaire

- Physical Examination with Stress Test

- 24 hour pad test

 

Are you a male suffering from stress incontinence? Feel free to read our guide to stress incontinence in men for useful guidance and tips.

What should you consider before having Stress Incontinence Surgery?

• Pregnancy can affect your decision. The strain of pregnancy and childbirth often causes surgical treatments to fail. You may wish to wait until you no longer want to have more children before choosing surgery.
• Ensure you have an accurate diagnosis of stress incontinence. Different types of incontinence require different approaches, so it is vital to ensure you have a proper diagnosis. You can read our stress incontinence section for more information on the symptoms.
• The surgery will only correct stress incontinence. If you have mixed incontinence, for example, your symptoms of urge incontinence will not be treated.
• Understand the risks. Before going ahead with a procedure, ask your Doctor about any potential risks to decide whether you are willing to go through with it.

What are the Different Methods of Surgery Available for you?

There are many different operations for correcting stress incontinence, but no procedure is always successful or without complications. The common options of surgery for stress incontinence are the following:

1. Colposuspension                                                        

Colposuspension is a fairly invasive operation that requires a general anesthetic. Experts recommend that you consider other options before choosing this method. This operation involves placing sutures in the vagina either side of the urethra and tying these sutures to ligaments to elevate the vagina. A cystoscopy (camera into the bladder via the urethra) is usually performed to ensure the sutures haven’t been placed in the bladder. The sutures in colposuspension elevate the vagina and support the urethra, reducing leakage.

The two types of colposuspension are the following:

• open colposuspension– this surgery is carried out through a large incision. This method involves making a large cut in the abdomen and provides great long-term success rates. This means post-operative healing times are longer.
• laparoscopic  colposuspension– in this method, surgery is carried out through more small incisions using special small surgical instruments. This procedure involves making a smaller cut, however the majority of people recover more quickly than with open colposuspension.

How Successful is it?                                        

Colposuspension has a success rate of between 50% and 70%. A recent Cochrane review included 39 trials involving a total of 3,301 women. Long-term follow-up showed an overall cure rate of 68.9 -88%, with a one-year cure rate of approximately 85-90%. Alcalay et al reported that the cure rate remained stable at 69 for 10-12 years, making it one of the most effective long-term treatments of stress incontinence.

Although effective, there are problems that can arise after colposuspension. Studies have shown that these include difficulty emptying the bladder fully when going to the toilet. It has also been shown to cause recurrent urinary tract infections (UTIs) and discomfort during sex.

2. Sling Procedure

The most common surgery used for stress incontinence, this procedure involves the creation of a “sling”, designed from mesh or human tissue. This sling is put under the urethra. It can then lift and support your urethra and the neck of your bladder to help prevent leaks.

How Successful is it?

There have been a number of reports of women suffering pain and injury after surgery, thought to be due to the sling which is made of non-absorbable plastic. A small portion of people who have the procedure also report developing urge incontinence afterwards. Due to improvements and research, however, the postoperative complication rates in 2018 are lower than previously reported. Overall, research has shown this method has an 88 to 95 percent rate in improving symptoms of incontinence.

3. Tape Procedure                                                                  

A tape procedure is designed to provide support in holding up the urethra to prevent leakages. In this procedure, a plastic tape is inserted through a cut inside the vagina and threaded behind the urethra. It is the middle part of the tape that supports the urethra. The two ends of the tape are then threaded through incisions in the tops of the inner thigh or the abdomen.

How Successful is it?                                                          

Studies over the years have shown that 2 in every 3 people experience no problems after the surgery. Individuals who still have occasional leaks after surgery still report that their incontinence is less severe than it was prior to the operation.

A temporary side effect of a tape procedure, however, is not being able to completely empty the bladder when you go to the toilet.  Some individuals have reported the need to go to the toilet more frequently and urgently after this procedure. On rare occasions, the tape can wear away or move over time and further surgery may be needed at a later stage to adjust it. It is common for individuals to require surgery to make the tape looser.

4. Urethral Bulking Agents

A bulking agent is a substance that can be injected into the walls of the urethra. The substances work to increase the size of the urethral walls, allowing the urethra to stay closed with more force. This is injected through a cystoscope inserted directly into the urethra. As a Urethral Bulking Agents procedure does not require any incisions, it is considerably more invasive than most methods of treatment.

How Successful is it?                 

A Urethral Bulking Agents procedure is slightly less effective than the other options available. Fewer than 4 out of 10 women report long-term benefits, although there are many success stories. The effectiveness of this method can also reduce with time and you may need repeated injections. Rare short-term side effects include experiencing a burning sensation or having temporary bleeding when passing urine.

If you are considering surgery for stress incontinence, ensure you talk to your Doctor and discuss the most appropriate method for you.

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