CAN SURGERY BE USED TO TREAT INCONTINENCE?

Some women try medications and exercises for relief of incontinence but still are plagued by bothersome symptoms. For these women, surgery may provide much needed relief. Surgery is most effective when stress incontinence is a major component of the incontinence, and it may help if some urgency accompanies stress incontinence. It is not likely to be effective for pure urgency or urgency incontinence.

One of the goals of surgery for the treatment of incontinence is the restoration, by a number of proven techniques, of the bladder and urethra to their normal position. Most women who have given birth vaginally have some degree of loosening, stretching and even tearing of the supporting ligaments of the vagina, bladder and rectum (see chapter 4). This weakening of the supporting ligaments usually begins unnoticed and without any symptoms and remains that way for the majority of women for their entire lives. But for some women, changes that occur as a result of the lengthening and stretching cause significant incontinence that interfere with their daily lives. Incontinence never jeopardizes a woman’s health, but it does play havoc with a woman’s ability to live and enjoy her life. For those women, surgery can restore a sense of basic good health and a return them to a life free of worry and wetness.

WHAT KINDS OF SURGERY CAN TREAT STRESS INCONTINENCE?

As described in chapter 1, stress incontinence occurs when the normal support structures of the pelvic organs weakens to the point where the position of the bladder and urethra changes when you laugh, cough, sneeze or do many activities for that matter. This weakness allows the force of a cough to push urine out of the bladder. If the bladder tests show that you have stress incontinence, a surgical procedure can be used to help hold the urethra and bladder in the correct alignment and prevent the loss of urine.

WHAT IS AN ABDOMINAL BLADDER SUSPENSION?

The typical way to correct the position of the urethra and bladder is with an operation known as an abdominal bladder suspension. This operation pulls the bladder and urethra back to a normal position, supported behind the pubic bone, and holds them there. The surgery is done through an abdominal, bikini-type incision. The tissue around the urethra and near the bladder opening is stitched to the ligaments attached to the pubic bone (see fig 6-2). This operation is called a Burch procedure, named after the doctor who developed it.

Another variation of this procedure is called a Marshall-Marchetti-Krantz (MMK) procedure, named after the three doctors who developed this operation. With this procedure, rather than placing the stitches into the ligament, the stitches are placed directly into the covering on the pubic bone. However, in rare cases, a difficult-to-treat inflammation, or even infection, may occur where the sutures are placed into the bone. This problem does not occur with Burch procedures. So while some gynecologists successfully use the MMK procedure, most gynecologists now prefer the Burch procedure to correct stress incontinence.

With either the Burch or MMK abdominal suspension procedures, the sutures are fixed to a solid object and stay in one place. This security and immobility makes these repairs strong and long lasting. The long-term success (5 years) for curing incontinence with an abdominal bladder suspension procedure is excellent, about 80%.

WHAT IS TVT?

The tension-free Sweden in 1995. This procedure is similar to the sling in principle it forms a hammock under the urethra that bolsters it when you laugh, cough, exercise, or strain in any other way.

This procedure has been performed on over 150,000 women in Europe and 20,000 in the United States, and the initial results are excellent. The success rate so far is 85% after 3 years. Surgery vaginal tape procedure, or TVT, is a new procedure first developed in takes about 30 minutes and may be performed with local or epidural anesthesia. Most women can leave the hospital within a few hours. Patients can urinate without problems immediately after surgery.

A thin strip of supporting tape is used to form a hammock under the urethra. (see fig 6-3) The tape is made of a synthetic nylon-like mesh that grips the surrounding tissues and holds itself in place without sutures until scar tissue grows into the mesh. Like the sling, the procedure is performed through a small incision in the vagina directly below the urethra. A loose hammock is made beneath the urethra, and the ends of the hammock are pulled up through two very small (1/2 inch) incisions made side by side in the skin just above the pubic bone. The tape is carried up to the abdominal wall with an instrument that avoids the need for the surgeon to make a tunnel. It’s faster and easier to perform than the sling. Once the tape is placed properly below the urethra, the extra material is trimmed, and the incisions on the skin’s surface are closed.

Because the procedure is new, long-term outcomes (5-10 years) and risks are still being determined, but the results to date have been excellent. While the TVT was initially developed for stress incontinence, it has also been used with some success for ISD combined with stress incontinence. It is likely that this procedure will be useful for many women with incontinence, and we have been impressed with the results in our own practice.

• WHAT IS THE RECOVERY LIKE AFTER AN ABDOMINAL BLADDER SUSPENSION?
• WHAT IS A LAPAROSCOPIC BLADDER SUSPENSION?
• WHAT IS THE RECOVERY LIKE AFTER A LAPAROSCOPIC BURCH PROCEDURE?
• WHAT IS A SLING PROCEDURE?
• WHAT IS THE RECOVERY LIKE AFTER A SLING PROCEDURE?
• WHAT IS TVT?
• WHAT IS THE RECOVERY LIKE AFTER TVT?
• WHAT IS AN ANTERIOR REPAIR?
• WHAT IS A VAGINAL BLADDER SUSPENSION?
• WHAT IS THE RECOVERY LIKE AFTER A VAGINAL BLADDER SUSPENSION?
• CAN SURGERY BE USED TO TREAT MIXED INCONTINENCE?
• CAN COLLAGEN INJECTIONS BE USED TO TREAT INCONTINENCE?
• HOW SUCCESSFUL ARE COLLAGEN INJECTIONS?
• WHAT IS AN ARTIFICIAL URINARY SPHINCTER?
• WHAT IS INTERSTIM?
• HOW SUCCESSFUL ARE THESE BLADDER OPERATIONS?
• HOW DO YOU DECIDE WHICH OPERATION IS BEST FOR YOU?
• CAN REPEAT OPERATIONS BE NECESSARY?
• WHAT LIFELONG PRECAUTIONS SHOULD BE TAKEN AFTER ALL BLADDER SURGERY?

Edited Excerpts from our book
The Incontinence Solution

By William H. Parker, MD, Amy E. Rosenman, MD, and Rachel Parker

Order The Incontinence Solution directly from Amazon.com.

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