Understanding and Exploring Surgical Options for Stress Incontinence

What Is Stress Urinary Incontinence?

Stress urinary incontinence is characterized by a person's inability to control the urge to urinate under different circumstances. Sometimes this condition becomes a mental trauma for the patients as they feel embarrassed and face social isolation. An important point to be noted about this condition is that stress refers to the pressure on the bladder, not stress in the physical sense. This condition might arise anytime during coughing, laughing, sneezing, and exercising. Females most commonly experience stress urinary incontinence, especially old-age females. In addition, females of childbearing age are more likely to experience stress urinary incontinence. The condition can be controlled by surgical intervention, pelvic floor exercises, or kegel exercises.

How Is Stress Urinary Incontinence Managed?

Several treatment methods are available to manage stress incontinence. However, all these methods depend upon the causes and severity of incontinence. For example, a patient with mild stress urinary incontinence can do kegel exercises to strengthen the pelvic muscles. The patient can also consult the doctor to know about fluid consumption. In addition, the patient must have a healthy lifestyle and refrain from smoking, alcohol, and avoid foods or substances that irritate the bladder.

What Are the Goals and Risks of the Surgery?

Though several methods are available to manage stress urinary incontinence, surgery is preferred in females who do not achieve the desired results with other treatments. Sometimes, surgery can increase the chances of complications but also provide a long-term solution. The doctor decides the best surgical options depending on the risk and benefits of the procedure. The treatment goals and risks of the surgical procedures are listed below:

Treatment Goals:

• The patient might experience pressure on the urinary bladder due to stress incontinence resulting in decreased functioning of the urethra.

• The tube-like structures attached to the kidneys on either side are known as ureters.

• The junction between the urinary bladder and the urethra is known as the bladder neck.

• The muscles that help keep the urethra closed are external urethral sphincters.

• Stress incontinence surgery aims to support the urethra and bladder neck.

• When the patient's bladder, neck, and urethra get extra support, the urethra remains closed and does not cause urine leakage.

Risks of the Surgery: Almost all surgical procedures are associated with certain risks. Hence, the risks associated with stress urinary incontinence surgery are listed below:

• Difficulty in passing urine.

• Urinary retention or difficulty in emptying the bladder.

• Urinary tract infections.

• Overactive bladder.

• Pain during sexual intercourse.

• Wound infections.

• Vaginal discharge.

• Groin pain.

What Things Should the Patient Consider Before Undergoing Surgery?

Before undergoing surgery, the patient must consider the following factors:

1. The patient must consult a urologist before undergoing surgery. This is because there are different varieties of urinary incontinence surgeries. Therefore, a proper diagnosis before surgery is crucial.

2. The patient needs to understand that surgery only resolves the problem that it is designed to treat. It does not treat the sudden and severe urge to pass urine. Patients with mixed incontinence (overactive bladder and stress urinary incontinence) will require additional treatments.

3. The doctor might recommend the patient wait for the surgery until the pregnancy is complete.

What Are the Different Types of Stress Urinary Incontinence Surgeries?

The different types of stress urinary incontinence surgeries are described below:

Sling Surgery - It is a common procedure in which a sling is used to support the bladder neck, or urethra. The sling can be made from a synthetic material or derived from the tissues of the patient's body. The surgeon will discuss the advantages and disadvantages of different surgical materials and how the sling can be placed. There are chances of erosion of a synthetic mesh. The time of recovery varies according to the procedure. Usually, the patient recovers and returns to daily activities within two to six weeks. The patient will receive instructions on when to resume his sexual activities.

• Tension-Free Slings - It is a mesh-like structure derived from a synthetic material like polypropylene. The sling works like a hammock that supports the urethra and is stabilized by the body tissues rather than the stitches. The healing is complete only after scar tissue forms in and around the mesh to prevent it from moving. The surgeon might recommend one of the following approaches to carry out the tension-free sling procedure:

Retropubic Procedure - The doctor makes a small incision into the vagina to access the urethra. In addition, two small incisions are also made above the pubic bone on either side. The surgeon passes each end of the sling from the vagina to the abdomen using a needle. The soft tissues hold the sling in position. Finally, the vaginal incisions are closed with absorbable sutures and sealed with glue or stitches.

Transobturator Procedure - The surgeon makes a small incision in the vagina and on either side of the groin. This procedure is similar to a retropubic one. The only difference being the mesh passes through the muscles of the groin rather than through the abdominal walls.

Both the procedures mentioned above are safe and effective, but the trans-obturator procedure works better and is convenient for the patient.

• Conventional Slings - This procedure mainly uses the body tissues to support the neck of the bladder. The doctor collects tissues from the abdomen or the thighs to form a sling. Next, the doctor makes an incision in the vagina and places the sling beneath the urethra near the bladder neck. The surgeon sutures each end of the sling to the abdominal wall. This procedure mainly requires an incision more extensive than the tension-free sling. Hence, the patient might need to stay in the hospital for a day or until the recovery is complete. The patient might also require a catheter after the surgery until the healing is complete. A conventional sling procedure is also associated with difficulty in emptying the bladder. Hence, this procedure is mainly reserved for females who have undergone incontinence but still suffer from urinary incontinence.

• Suspension Procedure - This procedure mainly supports the urethra and bladder neck by lifting the tissues around them. The Burch procedure is the commonly used method to carry out the suspension procedure. In this procedure, an incision is made in the lower abdomen. Next, the doctor attaches one end of the thread to the outer vaginal wall and the other to the ligament near the pelvic bone. When the sutures become tight, the vagina shifts upwards to support the bladder neck.

Conclusion:

Stress urinary incontinence is a common condition and must be treated soon to prevent further complications. Though several non-surgical methods are available to treat stress urinary incontinence, surgical intervention is required for patients who do not get relief from the non-surgical methods. Hence, the patient must consult the doctor soon to know more about the surgical techniques for stress incontinence.