Urinary Incontinence in Women

There are several different kinds of surgeries to correct stress incontinence, which results when weakened pelvic floor muscles allow the bladder neck and urethra to drop. These surgeries seek to lift the urethra and/or bladder into the normal position. This makes sneezing, coughing, and laughing less likely to make urine leak from the bladder.

Surgery is usually not done for urge incontinence.

The decision to have surgery must always be based on an accurate diagnosis, consideration of other treatment possibilities, and realistic expectations for the surgery.

Surgery Choices

• Tension-free vaginal tape (TVT) surgery. TVT surgery is commonly used for stress incontinence. During this surgery, a meshlike tape is positioned under the urethra like a sling or a hammock to support it and return it to its normal position. The surgeon inserts the tape through small incisions in your vagina and pubic hair line. TVT surgery takes approximately 30 minutes and is usually done under local anesthesia. This surgery can also be done to correct incontinence that has come back after having another type of incontinence surgery.
• Retropubic suspension. The Marshall-Marchetti-Krantz (MMK) and Burch colposuspension procedures are the most common types of retropubic suspension. Retropubic surgeries provide lift to the sagging bladder neck and urethra by attaching their supporting tissues to the pubic bone or tough ligaments. These surgeries require hospitalization.
• Urethral sling. The surgeon fashions a piece of muscle, ligament, or tendon tissue or synthetic material into a sling that lifts the urethra back into a normal position. Since this involves abdominal surgery, hospitalization is required.

What To Think About

The transobturator tape (TOT) surgery is like TVT surgery. But because it is newer, experts can't yet say how safe and long-lasting it is.²

Factors that may decrease the effectiveness of surgical treatment include obesity, long-term (chronic) cough, radiation therapy, aging, low estrogen level after menopause, poor nutrition, and strenuous physical activity.

Most surgical failures are due to incorrect diagnosis. Other reasons for failure include surgery that is not done well, healing problems, obesity, and additional causes of incontinence that could not be identified before correcting the primary cause.