Surgical Treatment of Stress Incontinence

Surgical Treatment of Stress Incontinence
Urinary incontinence is a common complaint for women after childbearing and the problems can worsen over time. Conservative therapy options are available and can be effective for mild stress incontinence. For those with moderate to severe incontinence who have not improved with conservative treatment, surgery is an option.

Minimally invasive procedures are currently the ideal approach for modern incontinence care. In the past retropubic urethropexy surgeries like the Burch or MMK procedure were considered the “gold standard” but these were quickly replaced by bladder neck suspensions such as the stamey procedure and the bladder neck slings. They were less invasive than the retropubic procedures with comparable outcomes. Another procedure is the periurtheral injections which offered some improvement but was far from the cure offered by the slings and the retropubic urethropexies.

Currently the most popular and effective surgical treatment is the mid-urethra sling which is a minimally invasive procedure that is highly effective and has a low risk of complications. The success rate ranges from 80-90% and is comparable to the Burch procedure with many more advantages. This procedure was first described in 1993 and has rapidly become the surgery of choice for female stress incontinence. The ease of the procedure and low complication rate has made it possible for many more women to achieve a cure. By 2006, 1/1000 women in the U.S were taking advantage of the availability of anti-incontinence surgery.

Since its introduction as the tension free tape (TVT), the mid-urethral sling has undergone a number of improvements. Currently this sling is available in 3 different approaches: the retropubic, the transobturator and the single incision sling. Each has its advantages and disadvantages and surgeons have their personal preferences. The cure rate for the retropubic version is 85-92 % while the cure rate for the transobturator approach is 73-81%. The complication rates tend to be a bit higher with the retropubic approach which is why the transobturator approach is popular. The single incision sling is relatively new had as a reported 1 year success rate of 76%.

Stress incontinence can be cured or improved. Effective surgeries are available and can be done via minimally invasive techniques. The most important step is to select the right provider and be clear on the options. Surgery should only be undertaken if the severity of the symptoms warrant the surgical risks. It is prudent to first consider conservative therapy, especially if the symptoms are mild.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!

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