Surgery may be considered if conservative measures are unsuccessful. Before making this decision, a woman should discuss the risks and benefits of surgery with her consultant specialist.
A number of different surgical procedures can be used. Only surgeons who have had specialist training in incontinence surgery should carry out these operations.
Tension free vaginal tape procedure for stress incontinence
TVT procedure is currently suspended
NHS England announced a national 'pause' on use of TVT tape to treat stress urinary incontinence
Autologous fascial 'natural tissue' sling for stress incontinence
The autologous fascial sling operation involves making a sling from your own natural tissue (the fascia - a layer of strong tissue beneath your skin) that is harvested from your abdominal wall (tummy). This 'natural tissue' sling is then used to support your urethra.
The fascial sling is inserted in a similar manner to themid-urethral synthetic sling (TVT). The success rate of synthetic TVT slings and fascial slings appear similar, in the range of 70-95%, although less data has been published on the fascial sling. Because fascial sling procedures involve making a bigger incision on the tummy, the recovery afterwards takes longer than TVT sling. The benefit of a fascial sling procedure is that no synthetic material is used.
Laparoscopic colposuspension for stress incontinence
In laparoscopic colposuspension, stitches are placed between the vaginal wall either side of the neck of the bladder and some fibrous tissue behind the pubic bone. This lifts the neck of the bladder to give it better support. Originally this operation required a bikini line cut in the tummy but it can now be done through laparoscopic (keyhole) surgery meaning a quicker recovery. This operation has been performed for over forty years and so we have good information about how well it works, although most of the studies reported on women who had open rather than keyhole surgery. 80% of women will be cured of stress incontinence following this operation.
Bladder neck bulking injections for stress incontinence
In bladder neck bulking, a bulking agent is injected into the walls of the urethra. This increases the size of the urethral walls and allows the urethra to stay closed. This is less invasive than other surgical treatments, as it does not require any incisions. However, it is less effective than the other options, and this effectiveness reduces with time.
Bladder 'BOTOX' (Botulinum toxin A) injections for urge incontinence
Bladder Botox injections: many people have heard of Botox for the treatment of face wrinkles! Botox works for the bladder by relaxing the muscle of the bladder wall (the detrusor muscle) reducing urinary urgency and incontinence. The latest evidence suggests that this may cure incontinence or improve symptoms by 70-90%. The effects can last for up to 12 months.
The Botox therapy for OAB is recommended by NICE when other measures such as physiotherapy or medicines fail to control problems.
- IUGA: statement on mid-urethral slings
- NICE: the management of urinary incontinence in women
- NHS: urinary incontinence treatment options
- Continence Foundation