Types Of Bladder Surgery For Incontinence

What Is Incontinence Surgery

Sometimes incontinence can have an adverse effect on your quality of life.

When youve exhausted conventional treatments and the ever-present symptoms still pose as a major disruption to your every day activities, it may be time to look at a more radical solution, like surgery.

Although it is more invasive and has a higher risk of complications than other therapies, urinary incontinence surgery can also provide a long-term solution in severe or persistent cases.

Your surgical options depend on the type of urinary incontinenceyou have. Most options for urinary incontinence surgery treat stress incontinence. However, surgical alternatives are available for other bladder problems, including urge incontinence.

Treatment For Urge Incontinence

There are several different types of treatment for urge incontinence.

• Bladder training. This is usually the first treatment. Youll be asked to do it for six weeks to see if it works. The training includes lengthening the time between planned visits to the toilet. Distraction and relaxation techniques help you control the urge to pee.
• Medicines. Your doctor may offer medicines called anticholinergics . These help to stop the muscle in your bladder from tightening when it shouldnt. They can take about a month to work and can cause a dry mouth and constipation. But these can be signs that the medicine is working.

If these treatments dont work, there are other options.

• Botulinum toxin A. This is injected into the wall of your bladder. It helps to stop the muscle in your bladder being overactive.
• Nerve stimulation. This involves sending electrical signals to the nerves that control your bladder.
• Surgery. There are two main types of surgery for urge incontinence. One involves making your bladder bigger . The other redirects urine away from your bladder into a bag . Both are major operations and only used if other treatments havent worked.

Each treatment comes with risks and benefits. Talk to your doctor about your treatment options. Make sure you have all the information you need to decide whats best for you.

Holmium Laser Enucleation Of The Prostate

In a high-tech procedure known as holmium laser enucleation of the prostate, your NYU Langone surgeon uses a laser to remove the prostate tissue that is blocking urine flow, without damaging the surrounding tissue. Performed under general anesthesia in the hospital, this procedure involves removing, or enucleating, prostate tissue that is blocking urine flow by cutting, or morcellating, it into small, easily removable pieces using a laser.

Men who undergo this procedure can expect to recuperate at home and return to work in less than a week. Temporary side effectsincluding blood and burning with urination, an increase in the frequency and urgency of urination, and mild urine leakagecan last for up to four weeks.

During recovery, you can perform most of your usual activities, except for sexual or strenuous activities.

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Why Is Bladder Suspension Surgery Done

Bladder suspension surgery is a procedure that can be used to treat urine leakage that occurs when a person sneezes, laughs, or coughs — a condition called stress incontinence. Childbirth, as well as hormonal changes that come with menopause, can cause a woman to lose muscle tone along the pelvic floor. That can lead to stress incontinence.

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Behavioral And Lifestyle Changes

Changing your lifestyle may help with bladder problems. Losing weight, quitting smoking, saying no to alcohol, choosing water instead of other drinks, and limiting drinks before bedtime can help with some bladder problems. Preventing constipation and avoiding lifting heavy objects may also help with incontinence. Even after treatment, some people still leak urine from time to time. There are bladder control products and other solutions, including disposable briefs or underwear, furniture pads, and urine deodorizing pills that may help.

Visit the National Institute of Diabetes and Digestive and Kidney Diseases for more information on urinary incontinence in men and urinary incontinence in women.

What Is Surgical Bladder Suspension

Bladder suspension surgery, also known as bladder neck suspension, is a procedure that is used to treat stress incontinence in women. There are a variety of types of bladder suspension surgeries that use stitches to support the bladder and urethra.

The goal of the procedure is to lift the bladder and urethra by lifting it and securing it to nearby structures such as the pelvic bone. The bladder is less likely to leak after the procedure.

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What Is The Colposuspension Procedure

This is a more invasive operation which requires a 45-60 minute procedure and a hospital stay of 3-4 nights. Longer recovery times and resulting scarring, much like a caesarean section scar, means this procedure is less common in modern times. A more popular treatment option now is the newer mid-urethral tape procedures, which have a shorter operating time, fast recovery and minimal scarring.

However, colposuspension may be recommended by a subspecialist urogynaecologist if a previous continence operation has failed.

Frequently Asked Questions Expand All

• What is stress urinary incontinence ?

  Stress urinary incontinence is the leakage of urine with physical activity, such as exercise, or when coughing, laughing, or sneezing. It is a common problem in women. SUI can be treated with both nonsurgical and surgical treatment methods.

• What causes SUI?

  SUI is a pelvic floor disorder. These disorders occur when tissues and muscles that support the urethra, bladder, uterus, or rectum are damaged.

  In SUI, the sphincter muscle that controls the flow of urine from the bladder to the urethra may weaken. Or the muscles that support the position of the bladder and the urethra may weaken. Weakness in these muscles may occur from pregnancy, childbirth, or aging.

• What nonsurgical treatments may help with SUI?

  If you have SUI and your symptoms bother you, your health care professional may suggest nonsurgical treatments first. Lifestyle changes, such as drinking less fluid, limiting caffeine, stopping smoking, and losing weight, can help decrease the number of times you leak urine.

  Other nonsurgical options include pelvic muscle exercises , physical therapy and biofeedback, or use of a pessary. Another option is an over-the-counter product that is inserted into the like a tampon. If these treatments do not improve the problem, surgery may help.

• What are the surgical treatments for SUI?

  Surgery improves SUI symptoms in most women. There are different types of surgery for SUI:

• Colposuspension

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Types Of Bladder Suspension Surgery

There are different ways to place the bladder back to its normal position. Bladder suspension surgical techniques include:

• Open retropubic suspension surgery
• Laparoscopic retropubic suspension surgery
• Needle bladder neck suspension surgery

Open retropubic suspension surgery involves pulling up the bladder neck and sewing it to the surrounding bone or tissue with sutures. It is a form of abdominal surgery. The surgeon makes an incision in the belly area a few inches below the belly button and locates the bladder and urethra, the tube through which urine flows out of the body. The procedure improves symptoms of stress incontinence that result from sagging of the bladder neck or urethra.

Laparoscopic retropubic suspension surgery has been around since the early 1990s. It uses a smaller incision than the open procedure. However, some studies show that laparoscopic bladder suspension results in a higher complication rate, and that the open technique tends to produce higher cure rates. Recent research suggests that these procedures could allow for a speedier recovery and offer other advantages, but more research is needed to check long-term safety and effectiveness.

Needle bladder neck suspension surgery may be done through the abdomen or . However, it does not appear to work as well as stress incontinence surgeries that are done through the abdominal wall.

What Are The Types Of Bladder Surgeries

Most bladder surgeries are now done robotically, meaning that your surgeon will just make a small number of incisions and then place ports that allow the use of robotic arms to perform the surgery. Few are open surgeries where theres a long cut. Types of surgeries include:

Bladder cancer is the most common reason for people to undergo bladder surgery. Depending on the stage and progression of bladder cancer, surgery can be used in combination with other therapies such as chemotherapy or radiation therapy. To treat bladder cancer, many different types of procedures may be done. Those procedures include:

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What Are The Possible Complications Of Bladder Surgery

There can be complications of bladder surgery. You are at higher risk if you are over the age of 60 or designated female at birth. Possible problems include:

• Gastrointestinal problems: Abdominal surgeries can interfere with your bowel functions. Talk to your healthcare provider about how to handle GI issues.
• Reproductive health in men: Bladder cancer can spread to your prostate. During bladder surgery, your prostate may also be removed, which may impact your fertility.
• Reproductive health in women: If your uterus is removed as part of bladder cancer surgery, you won’t be able to get pregnant.
• Urinary diversion: If you have a procedure that reroutes your urine , you may have complications. Pee could leak from the opening made in your body, and there could be an infection.
• Hormonal changes: If your bladder cancer has spread to your ovaries, they may need to be removed. Menopause will begin.
• Inability to urinate: Some people, especially women who have had more than their bladder removed, are unable to pee right away. This usually lasts no longer than a week. Youll be given a catheter and a leg bag . Your healthcare provider will teach you how to operate the equipment.

Types Of Bladder Surgery

• Bladder Suspension Surgery . A prolapsing, dropping, or sagging bladder is returned to its correct position. It treats stress incontinence, which is urine leakage when a person coughs, sneezes, or laughs. There are several ways to perform bladder suspension surgery. The surgeon may make incisions in the abdomen and pull up the bladder neck. To keep the bladder neck in place, they sew the bladder neck to surrounding tissue or bone. A newer more common method is to use a sling or hammock-like structure to support the bladder neck. The structure can be made out of body tissue or man-made materials such as polypropylene.
• Transurethral Resection with Fulguration. A thin lighted tube called a cystoscope is inserted through the urethra to the bladder. While inside the bladder, surgeons use a tool with a small wire loop to burn away cancer formations. Its effective on tumors as well.
• Segmental Cystectomy. Part of the bladder is removed in segmental cystecomy. It can be performed in some instances of bladder cancer invading the muscle wall. As long as the cancer is only in one part of the bladder, segmental cystectomy is an option.
• Radical Cystectomy. If bladder cancer has spread to the muscle wall or inflicts a large part of the bladder, the patient may undergo radical cystectomy. In this surgical procedure, the surgeon removes the bladder and any lymph nodes or organs that contain cancer.

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What Is The Urethral Bulking Agents Procedure

This procedure involves injecting a substance into the urethral walls, around the bladder neck. The procedure aims to increase the size of the urethral walls to allow the urethra to stay closed more strongly.

Bulking procedures are recommended for women with stress incontinence or those who have difficulties emptying the bladder. It can also be used in more complex cases, such as in women who have had previous continence operations.

This is a short procedure, carried out under general anaesthetic and one which requires no incisions or stitches to be made. Women can typically go home the same day.

However, it does not have the same success rate or long-lasting effects as a mid-urethral tape or colposuspension, so it is usually recommended as a second-line treatment option. Bulking agents will wear off over time, so repeated injections are often necessary.

When To Call The Doctor

• Fever over 100°F
• Vaginal discharge with an odor
• A lot of blood in your urine
• Difficulty urinating
• Swollen, very red, or tender incision
• Throwing up that will not stop
• Shortness of breath
• Pain or burning feeling when urinating, feeling the urge to urinate but not being able to
• More drainage than usual from your incision
• Any foreign material that may be coming from the incision

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Can Men Have Successful Surgery For Incontinence

Surgical treatment of stress urinary incontinence is useful when men have incontinence to such a degree that they are bothered by the leakage. This may be different for each man, as levels of activity and the degree of inconvenience felt with the use of pads or adult diapers varies. Determining the amount of incontinence can be based on number of pads used per day and how soaked the pads are when changed. A physician specializing in bladder health will ask patients questions about pad use during a patients visit to the office. When a man is more active , it tends to lead to more stress urinary incontinence. Men who find themselves limiting their activity due to fear of getting wet pants or who are troubled with their pad use should speak with a surgeon to discuss surgical treatment for stress urinary incontinence. There are options to keep them active! In fact, there are several devices that can be placed during a straightforward operation to help men dealing with incontinence. The male sling and artificial urinary sphincter are well established treatments to provide men with long-term urinary control.

What Happens After Bladder Surgery

The specifics of recovering from bladder surgery depend a lot upon the type of bladder surgery that you have. For example, in a transurethral resection much less tissue is removed or changed in the surgery than during a radical cystectomy where the entire bladder is removed. Thus, the recovery time after your procedure can vary. Your healthcare provider will help guide you through the recovery process including a voiding trial and catheter care instructions.

Not long after your surgery, youll need to get checked out again by your healthcare provider. Report any problems youve had since your procedure. If youve had bladder cancer, they might need to insert a camera into your bladder to check it.

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How Are Minimally Invasive Surgical Procedures Performed

The most commonly used and effective treatments for urinary incontinence, both male and female, imply a small procedure. These are more effective and definitive than non-invasive techniques. For each specific patient, the pros and cons of each type of treatment have to be considered. These procedures use anaesthetic, but patients are usually discharged from hospital on the same or next day.

Surgical procedures and the way they are performed depend on the technique chosen. Some are performed endoscopically, such as bulking injections, while others involve making a small incision in the skin.

The most common treatments are the following:

• Bulking injections
• Insertion of inflatable or non-inflatable suburethral slings
• Artificial urinary sphincter.

Some surgeries, such as the insertion of an artificial sphincter, may be recommended for some patients, e.g., when changes to cognitive or motor capacity exist

What To Expect During A Surgical Bladder Suspension

A bladder suspension procedure is typically performed in a hospital setting under general or spinal anesthesia. Depending upon how much bladder support is needed, your doctor will determine the type of procedure that will be used.

Surgical options include:

• Open retropubic suspension surgeryDuring an open procedure, your doctor will make a large incision in the abdomen to access the bladder. Once the area is open, your doctor will locate the bladder and urethra, pull the bladder neck up and sew it into the nearby bone or tissue.
• Laparoscopic retropubic suspensionDuring a laparoscopic procedure, your doctor will make two to three smaller incisions into the abdomen and above the pubic bone. Small surgical instruments will be used to perform the procedure. Although laparoscopic retropubic suspension allows for a quicker recovery and shorter hospital stay, results show higher complication rate.
• Transvaginal procedureDuring a transvaginal bladder suspension, a small incision is made in the front of the vaginal wall to access the bladder and urethra. Once accessed, your surgeon will lift the bladder neck and sew it into the surrounding bone or tissue.
• Sling surgeryDuring a sling surgery procedure, your doctor will create a hammock-like structure that will cradle the bulging bladder. The sling will support the bladder and urethra to help relieve the symptoms of stress incontinence. In many cases, your doctor can use your own tissue from your abdominal wall or use donor tissue.

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What Does The Bladder Do

Your urine bladder , stores your pee after your kidneys filter it. Pee goes from your kidneys down the ureters and into your bladder, where its stored before exiting your body through your urethra.

Your bladder is made of muscular, flexible tissues that can expand bigger or shrink smaller depending on how much pee it contains. The muscles in your bladder contract when they push your pee through your urethra.

When Is Surgery Required

There are a range of surgical procedures to treat many bladder related conditions and you should consult your doctor about which best suits you.

Kimberly-Clark Australia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice.

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