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Surgical Correction of female stress incontinence is based upon the support of the upper urethra and bladder neck to allow the normal twisting contractions of the urethral muscles to control urine flow. There are many different operations used to accomplish this. Some require an open abdominal surgery, some a limited superficial incision in the lower abdominal skin and fat, and or a vaginal approach, and some are done by laparoscopy. Most forms of surgical repair have excellent results when the appropriate operation has been selected for the patient's condition. None of the repair procedures has a perfect record, there are a small percentage of failures or partial responses. In general 85 to 90+% of patients will regain good to excellent urinary control.
Most urologists and urogynecologists are doing one of the variations of sling procedure during which a strip of material is placed under the bladder neck and/or urethra and anchored to the pelvic bones, or abdominal wall. There are many variations of this procedure most through a vaginal incision plus small skin incisions, some through an abdominal incision, athough these are becoming rarer. Variations may or may not anchor the sling. If there is a cystocoel or "fallen bladder" an additional patch may be used to hold the bladder in place. The slings and patches are made of many different materials varying from donor or animal tissues to reconstituted or synthetic products. Names assocciated with these procedures include OBtape, TVT, Apogee, Perigee, and many others. The trans vaginal approach is frequently done as an in and out procedure or perhaps with an overnight admission. There is some, usually minimal, discomfort. Results are generally good to excellent, but a small number of fair to poor results do occur. Return to most activities is within a week or so, although many surgeons recommend waiting 6 weeks before indulging in heavy exercise or sex depending on the type of procedure done. Rarely, the patient is unable to void, and requires intermittent catheterization for a period of time, or even more rarely, permanently. There are multiple other procedures that repair the problem by attaching the bladder neck and or urethra, and or vaginal tissues to the pubic bones or anterior abdominal wall. Some are done through the vagina, some through the abdomen and some laparoscopically. Hospital and down time vary with the procedure, and short term results are generally similar. With all the repairs, long term failure over a period of years is not uncommon, although the sling procedure may prove to have better long term results as it adds new tissue for support. Only time will tell. Rev:07/05 [Treatment of Incontinence] |
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[Home] Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc Greenbelt - Bowie - Laurel Maryland (301) 441-8900 Fax (301) 982 0453 7500 Hanover Parkway Suite 206 Greenbelt, MD 20770
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