Urinary Incontinence Surgeries

Urinary incontinence surgeries can help people who continue to experience troublesome urine leakage despite lifestyle changes, pelvic floor exercises, medicines, or other non-surgical treatments. The appropriate procedure depends on the type and severity of incontinence, the patient's sex, previous surgeries, bladder function, general health, and the underlying cause.

What Is Urinary Incontinence?

Urinary incontinence is the involuntary leakage of urine. It can range from occasional leakage while coughing or sneezing to frequent or severe leakage that affects daily activities and quality of life.

Common types include:

• Stress urinary incontinence: Leakage occurs when pressure is placed on the bladder during coughing, sneezing, laughing, exercising, or lifting.
• Urge urinary incontinence: A sudden, strong need to urinate is followed by involuntary leakage.
• Mixed urinary incontinence: A combination of stress and urge symptoms.
• Overflow incontinence: The bladder does not empty properly, resulting in frequent dribbling or leakage.
• Functional incontinence: Physical or cognitive difficulties make it difficult to reach or use the toilet in time.

Surgery is mainly considered for selected patients with stress urinary incontinence and certain complex cases. Urge incontinence is usually managed with bladder training, medicines, lifestyle measures, and other treatments before surgery is considered.

When Is Surgery Recommended?

Not everyone with urinary incontinence needs surgery. Doctors usually begin by identifying the underlying cause and considering conservative treatments.

For stress urinary incontinence, pelvic floor muscle training is commonly used as an initial treatment. Surgery may be considered when symptoms remain bothersome despite appropriate non-surgical management.

The European Association of Urology recommends shared decision-making when selecting surgery for stress urinary incontinence. Patients should understand the potential benefits, limitations, and risks of the available procedures.

Surgery may be considered when:

• Urine leakage significantly affects daily life.
• Conservative treatment has not provided adequate improvement.
• The diagnosis of stress urinary incontinence has been established.
• The patient is medically suitable for surgery.
• The expected benefits outweigh the potential risks.

Additional testing may be recommended in patients with complicated, recurrent, or mixed symptoms.

Common Urinary Incontinence Surgeries

1. Midurethral Sling Surgery

A midurethral sling is one of the commonly used surgical treatments for female stress urinary incontinence.

During the procedure, a sling is placed beneath the urethra to provide support when abdominal pressure increases. This can help prevent urine leakage during activities such as coughing, sneezing, or exercising.

Midurethral slings can be placed through different surgical approaches, including retropubic and transobturator routes. The choice depends on individual anatomy, symptoms, previous procedures, and the surgeon's assessment.

The EAU guidelines support offering midurethral sling surgery to appropriate women after discussion of its risks and alternatives.

2. Autologous Fascial Sling

An autologous fascial sling uses the patient's own tissue, commonly fascia from the abdominal wall, to create support beneath the urethra.

This may be considered for selected women, including those who require an alternative to synthetic sling material or have particular clinical circumstances.

Autologous slings are an established surgical option for stress urinary incontinence. However, they may be associated with postoperative voiding difficulties in some patients, so careful counselling is important.