Primary Surgical Treatments for Stress Incontinence in Women
Urethral slings are the most common and effective surgical treatment option for SUI. Your doctor will perform a minimally invasive procedure to place a sling, a small piece of synthetic mesh, under the urethra. The sling forms a hammock of support for your urethra, keeping it supported to eliminate accidental urine leakage.
Placement of the urethral sling is done as an outpatient procedure and only requires a small incision in the vagina. You can expect to go home a few hours after the procedure. Most women do not experience major pain or discomfort after the placement. You can return to light activity four to six weeks post-surgery; however, you should avoid heavy lifting, sexual intercourse and rigorous exercise for four to six weeks following your procedure. Your doctor will discuss post-operative instructions with you.
- A minimally invasive outpatient procedure
- An effective treatment for SUI for more than 30 years
- Many women see immediate results following placement of the sling
- Covered by most major medical insurance
- General risks associated with surgery
- Serious complications are very rare but can include trouble with urination following the procedure, a reaction to the sling material, or return to incontinence
Urethral bulking involves the injection of a special material called a bulking agent around the urethra. Your doctor can perform this minimally invasive procedure under local anesthesia in the office or in an outpatient surgical center. The bulking agent helps build up the thickness of the urethral wall to support the bladder and form a tight seal to prevent urine leakage. Using a periurethral or transurethral approach, your doctor will inject the bulking material into the area around the urethra.
- No incisions
- A quick procedure with minimal side effects
- Short recovery time
- May not work for some women
- Not a permanent treatment; may need to be repeated over the course of months to years
Secondary Surgical Treatment Options for SUI
Autologous Pubo-Vaginal Sling
An alternative to the urethral sling, the autologous pubo-vaginal sling is an option for women who do not wish to have the more common mesh sling implanted. This procedure utilizes the patient’s own fascia (connective tissue), taken from the thigh or lower pelvic area, to create the sling. Because your doctor uses your own tissue, there is no reaction to synthetic materials. The procedure, which is a more invasive, intricate surgery than a urethral sling, involves a small vaginal incision as well as two small incisions made above the pubic bone to insert and place the sling. A small incision in either the thigh or lower pelvis is also made to harvest the tissue.
Retropubic Suspension Surgery (Burch Procedure)
In some women, the bladder neck and urethra have dropped into the pelvic area, which causes involuntary urine leakage. Retropubic suspension surgery is a less common procedure that treats SUI by lifting the sagging bladder neck and urethra by attaching the bladder to structures behind the pubic bone to provide added support. This procedure is typically performed laparoscopically or through open surgery under general anesthesia through several small incisions in the abdomen.
Radiofrequency Bladder Neck Suspension
A less common alternative treatment, radiofrequency bladder neck suspension is a minimally invasive procedure where the pelvic tissue is gradually and precisely heated, allowing it to shrink and stabilize to keep the urethra from leaking. Your doctor may offer this therapy as a clinical trial or it may be offered off trial based on your insurance.