Introduction
Minimally invasive surgery, also known as minimal access surgery, is a surgical technique that involves performing surgical procedures with small incisions rather than the larger incisions required in traditional open surgery. In minimally invasive surgery, special surgical instruments and a small camera are inserted through the small incisions to access the surgical site, allowing the surgeon to perform the necessary procedures with precision and minimal disruption to surrounding tissues.
What Is Urinary Incontinence?
Urinary incontinence is a prevalent issue involving involuntary loss of bladder control and can be uncomfortable and awkward. The severity can vary from sporadic urine leakage during coughing or sneezing to a sudden and intense urge to urinate that is difficult to control. Although it is more common in older individuals, urinary incontinence is not a result of aging.
What Are the Components of Minimally Invasive Surgery for Urinary Incontinence?
Minimally invasive surgical techniques for urinary incontinence are quick, secure, and involve minimal invasion. Various procedures, such as coaptite urethral bulking injection and the insertion of devices to support or replace the urinary sphincter, can be carried out through endoscopic or open surgery using local, spinal, or general anesthesia. These techniques have shown promising results, and patients often experience an immediate cessation of urine leakage, making them highly satisfactory.
How to Perform These Surgeries?
Minimally invasive surgical procedures for urinary incontinence involve small-scale procedures that are highly effective and definitive, especially for male and female patients. The advantages, such as increased effectiveness, and disadvantages, such as the requirement for minimally invasive techniques, should be assessed for each patient's specific needs. These procedures use anesthesia, but patients are typically discharged on the same day or the next day.
The surgical techniques and methods depend on the chosen procedure, with some being performed endoscopically, such as bulking injections, while others require a small incision in the skin. The most common treatments include bulking injections, the insertion of suburethral slings (such as ATOMS), and the use of an artificial urinary sphincter.
Some surgeries, such as the insertion of an artificial sphincter, may be necessary for certain patients, such as those with cognitive or motor impairments.
-
Bulking Injections: Bulking injections are a minimally invasive treatment for urinary incontinence that involves injecting bulking agents, such as collagen, into the urethra to increase its resistance to urine flow. This technique can help improve urinary control by reducing the amount of urine leakage. Bulking injections are typically performed on an outpatient basis and can be an effective treatment option for certain types of urinary incontinence. However, the effects of the injection are only temporary and may require additional treatments over time. Bulking injections are carried out using endoscopic techniques while the patient is under sedation or general/spinal anesthesia. The procedure involves injecting a substance into the urethra to reduce its diameter. Several products can be used for this, with the substance being injected around or into the urethral wall to help the urethra close or coapt as a complement to the sphincter's action. This method is recommended for mild incontinence cases with low urine leakage, and the success rate is typically reasonable.
-
Insertion of Micro Balloons: In addition to bulking, an alternative treatment option for urinary incontinence involves implanting balloons using endoscopic techniques. The balloons are made of silicone elastomer and are filled with cross-linked hydrogel, which allows them to expand and press against the urethra. This procedure is also recommended for cases of mild incontinence.
-
Suburethral Slings: These techniques were initially developed for female urinary incontinence, but now they are used for both male and female patients. In these procedures, a sling is placed under the urethra to restore the pelvic floor and compress the urethra, which helps to stop urine leakage. The sling typically goes through an obturator hole, which is why they are called “trans-obturator” techniques. The type of sling used is different for men and women because of the differences in the anatomy and causes of incontinence. A thin rectangular tape is used for women, while for men, the slings have different configurations, such as adjustable and non-adjustable slings. The adjustable transobturator male system (ATOMS) is an example of an adjustable sling that can be inflated after the operation to achieve the right degree of urethral compression. These techniques are suitable for moderate to severe cases of incontinence, and they are minimally invasive procedures performed under general or spinal anesthesia with a high success rate. The tape helps to reposition and/or compress the urethra and bulb, which restores the normal functioning of the sphincter complex, and this helps the patient to urinate normally without leakage.
-
Insertion of Artificial Urinary Sphincter: This is the recommended treatment for moderate to severe urinary incontinence caused by sphincter failure, which often occurs in men following surgery on the prostate, bladder, urethra, or rectum, or in women with severe sphincter lesions. If conservative measures have been unsuccessful, an artificial sphincter should be implanted at least six months to a year after surgery. The procedure involves inserting a circumferential device with an inflatable cuff around the urethra to compress it. The patient activates the device when they want to urinate, which opens the urethra by moving the liquid inside the cuff away from the area. The urethra gradually closes again as the liquid returns to the cuff after urination, ensuring continence. This technique is suitable for more severe cases of incontinence where there is a high volume of leakage or even constant or continuous leakage and the patient experiences regular, frequent, or constant losses. The device is particularly helpful in situations where the patient cannot even fill the bladder.
How Do Patients Recover After Minimally Invasive Surgeries?
Patients can typically be discharged from the hospital on the same day or the next day after their first post-surgery urination. Hospital stays are usually less than 24 hours, which is beneficial for patients' comfort. After surgery, patients are advised to avoid exertion for a period of time (15 to 45 days), depending on the type of surgery. Additionally, patients are encouraged to eat fiber-rich foods to prevent constipation, which can negatively impact the surgical site.
What Are the Complications?
As with any surgical procedure, including minimally invasive ones, there are potential risks and complications. These may include:
-
Bleeding.
-
Infection.
-
Discomfort after surgery.
-
Slight possibility of developing a urethral or bladder injury, although this is rare.
Conclusion
In conclusion, minimally invasive surgical techniques for urinary incontinence are quick, secure, and involve minimal invasion. These techniques use various procedures, such as coaptite urethral bulking injection, the insertion of devices to support or replace the urinary sphincter, and the use of an artificial urinary sphincter, all of which can be carried out through endoscopic or open surgery using local, spinal, or general anesthesia. Minimally invasive surgical procedures for urinary incontinence involve small-scale procedures that are highly effective and definitive, especially for male and female patients. Patients often experience an immediate cessation of urine leakage, making them highly satisfactory. The type of procedure performed depends on the patient's specific needs, the severity of the incontinence, and the underlying cause. These procedures have shown promising results, and patients can recover quickly, often going home the same day or the next day.
