There are three main types of stress incontinence surgery: injections, urethral sling, or colposuspension. These procedures can support the urethra and tighten the bladder neck, which may reduce urine leakage.
The bladder neck is at the bottom of the bladder, where it meets the urethra. The urethra is the tube that carries urine out of the body.
By tightening the bladder neck, surgeries for stress urinary incontinence (SUI) may reduce symptoms. However, each procedure has its own set of potential benefits and risks.
Read on to learn more about stress incontinence surgery, including who is a good candidate for each type, success rates, and the potential risks.
The three main types of surgery for SUI are:
Injections
Injections for SUI involve injecting a synthetic material, such as collagen, into tissues around the urethra. This supports and tightens the bladder neck opening. Another name for the procedure is urethral bulking.
During the procedure, a doctor will administer a local anesthetic to numb any pain. They then insert a scope into the urethra and inject the material with a thin needle. It is a minor procedure that takes less than 20 minutes. A doctor may be able to perform it in their office.
Injections for SUI may reduce symptoms, but they are often not a complete cure. Some people may also need two to three injections to get results.
However, the procedure does not require any incisions and so is less invasive than other SUI surgeries. A person may be a good candidate for injections if nonsurgical treatments have not worked and if they prefer a less invasive treatment approach.
Urethral sling
Urethral slings are straps that can lift and support the urethra and bladder neck, creating a better position and narrowing the bladder opening. Doctors can place the sling by using an abdominal incision, a vaginal incision, or laparoscopy, which is a minimally invasive surgery that involves small incisions with the aid of a camera.
There are two types of urethral slings: midurethral and traditional.
Midurethral sling
The midurethral is the most common surgery for urinary incontinence. It entails placing a narrow strap made of a synthetic mesh under the urethra. The procedure typically takes less than 30 minutes, and a person may go home the same day.
Recovery time tends to be quicker than more extensive surgeries. However, it is not appropriate for people who plan to become pregnant in the future.
Traditional sling
The traditional sling is a strip of someone’s own body tissue, which a doctor threads under the urethra. The procedure may suit an individual who:
- had a previous reaction to synthetic mesh
- had complications from an earlier midurethral sling
- is undergoing urethral repair surgery at the same time
This requires a longer recovery period than a midurethral sling, as it involves a hospital stay of a few days.
Colposuspension
This surgery restores the part of the urethra nearest the bladder to its original position. The most common type is the Burch procedure, which involves putting a few stitches on either side of the urethra. This maintains the bladder neck in its position and helps support the urethra.
There are two types of colposuspension: the open type, which entails an abdominal incision, and the laparoscopic type.
The recovery time of the open type is similar to that of a traditional sling. An individual who has the laparoscopic type may go home the same day.
According to a
However, it is worth noting that while doctors consider this the best surgery in general, it is not necessarily the best option for every person. Some people have specific treatment needs that make a synthetic mesh sling problematic. For example, those who want to get pregnant may avoid having this procedure.
Others may prefer a less invasive treatment or have an adverse reaction to the procedure and need to try another approach.
As a result, there is no universal best option that will work perfectly for everyone with SUI. People can understand which surgery might be right for them by discussing it with their doctor.
According to the American College of Gynecologists (ACOG), surgery improves the symptoms of SUI for most people.
However, it is important to note that the
A 2017 review of previous research calculated that the median cure rate for all types of SUI surgery is
For example, after 12 months, the success rate for injections ranged from 24.8% to 36.9%. Colposuspension success rates were 76.6% for the open type and 48.9% for the laparoscopic type.
In contrast, a 2022 review of past research found that the success rate for urethral slings is between
SUI surgery has some risks. Some of these are risks that come with many surgical treatments, such as:
- bleeding
- infections
- scarring
- adverse reactions to anesthesia
- injury to nearby tissues, organs, or nerves
There are also some risks specific to each type of SUI surgery, such as:
- Urinary problems: Some people may continue having incontinence after the surgery. Others may have difficulty urinating. For example, this can happen if the stitches from colposuspension are too tight.
- Mesh erosion: There is a less than 5% risk of mesh erosion for people undergoing urethral sling surgery. This complication can cause pain, pain during sex, and infections.
- Need for adjustment: If the first surgery has adverse effects, such as mesh erosion, or does not work, a person may need further procedures to address the problem.
Following surgery, a person may experience pain or discomfort for a few days or weeks. The amount of pain varies among people, as does the recovery process.
Those who undergo abdominal surgery may have larger incisions and more recovery time than those who have vaginal or laparoscopic procedures.
Those who have more than one surgery at the same time may also have more pain and a longer recovery process.
Surgery may be unnecessary for people with SUI if they can get adequate relief from nonsurgical interventions. These
For example, it may help avoid things that irritate the bladder, such as:
- smoking
- alcohol
- caffeinated beverages
- spicy foods
- citrus foods
- chocolate
- tomato
Nonsurgical therapies may also improve symptoms, such as:
- exercises to strengthen pelvic floor muscles, including Kegel exercises
- bladder training, which involves regularly scheduled urinations to lead to an empty bladder for longer periods
- biofeedback, which may teach a person how to effectively contract pelvic floor muscles
- a pessary, which is a device that sits inside the vagina and puts the urethra in a more typical position
- electrostimulation using acupuncture needles
Medication options include:
- tricyclic antidepressants, such as amitriptyline (Elavil), to help with urethral contraction and closure
- oxybutynin (Ditropan, Ditropan XL) to decrease muscle spasms of the bladder and the frequency of urination urges
- topical estrogen to boost the effects of urethral contraction and closure
For some, these methods work well enough that they do not feel the need for surgery.
Stress incontinence surgery can help support the urethra and bladder neck, reducing urine leakage. The main types of SUI surgery include injections, urethral slings, and colposuspension.
When surgery is necessary, doctors generally consider a midurethral sling as the first-line choice. A person can expect pain or discomfort for a few days to weeks following surgery.
Surgery improves symptoms in most individuals, but it