Surgical Procedures Used to Treat Urinary Incontinence

Surgical procedures have been developed to correct issues that cause urinary incontinence, such as the removal of the obstructive part of an enlarged prostate gland in men or to correct a bladder or uterus that has slipped out of position in a woman. Common surgical procedures used to treat urinary incontinence include:

  • Artificial urinary sphincter. An artificial urinary sphincter is a small device that is particularly helpful for men who have weakened urinary sphincters from treatment of prostate cancer or an enlarged prostate gland. It is rarely used in women with stress incontinence. Shaped like a doughnut, this device is implanted around the neck of your bladder. The fluid-filled ring keeps your artificial urinary sphincter closed until you are ready to urinate. To urinate, you press a valve implanted under your skin that causes the ring to deflate, allowing urine from your bladder to be released. This is the most effective procedure for male incontinence. Although uncommon, complications include malfunction of the device, which means the surgery will need to be repeated, and infection.
  • Bulking material injections. This procedure involves injecting bulking materials, such as cow-derived collagen, carbon particle beads or synthetic sugars, into the tissue surrounding the urethra or the skin next to the urinary sphincter. It tightens the seal of the sphincter by bulking up the surrounding tissue. The procedure is done with minimal anesthesia and typically takes about two to three minutes. The effect can be lost over time and, as such, usually needs to be repeated after several months. There is a risk of rejection or infection.
  • Sacral nerve stimulator. A sacral nerve stimulator is a small device that acts on nerves that control bladder and pelvic floor contractions. The device resembles a pacemaker and is implanted under the skin in your abdomen. A wire from the device is connected to a sacral nerve – an important nerve in bladder control that runs from your lower spinal cord to your bladder. The device emits electrical pulses through the wire that stimulate the nerve and help control the bladder. The pulse doesn’t cause pain and provides relief from heavy leaking. Possible complications include infection, but the device can be removed.
  • Sling procedure. The sling procedure is the most popular and common surgery for women with stress incontinence. In this procedure, a surgeon removes a strip of abdominal tissue and places it under the urethra, or the surgeon may use a strip of synthetic mesh material, or a strip of tissue from a donor (xenograft) or cadaver. The strip acts like a hammock, compressing the urethra to prevent leaks that occur. In most cases, sling procedures improve or cure incontinence.
  • Bladder neck suspension. Bladder neck suspension involves a 3- to 5-inch incision in your lower abdomen. Through this incision, the surgeon places stitches (sutures) in the tissue near the bladder neck and secures the stitches to a ligament near your pubic bone (Burch procedure) or in the cartilage of the pubic bone itself (Marshall-Marchetti-Krantz procedure). It is used to bolster your urethra and bladder neck so they don’t sag. Bladder neck suspension involves major abdominal surgery. It is done under general anesthesia and usually takes about an hour. Recovery takes approximately six weeks, and you will likely need to use a catheter until you can urinate normally.

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