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B efor e t h e sur ger y:
• accurate diagnosis
• assessment by- incontinence specialist,
urologist or urogynecologist.
• For pre-natal women or women planning to
bear a child, doctors recommend holding off
the surgery- it may undo any surgical fixture.
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A i m of su r gi cal
m an agem en t :
• recreating urethral support allowing for the
normal functioning of the urethra during
increased abdominal pressures.
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A ppr oach es for St r ess
I n con t i n en ce
Abdominal approaches
• Retropubic colpo-suspension
– Burch
– Marshall-Marchetti-Krantz (MMK)
Contemporary
• Pubo-vaginal sling
• Tension free vaginal tape (TVT)
• Trans-obturator tape (TOT)
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Retropubic Colpo-suspension
• Retropubic suspension surgery is used to
treat urinary incontinence by lifting the
sagging bladder neck and urethra that have
dropped abnormally low in the pelvic area.
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P u bo-vagi n al Sl i n gs
• The procedure involves placing a band of sling
material directly under the bladder neck (ie,
proximal urethra) or mid-urethra, which acts
as a physical support to prevent bladder neck
and urethral descent during physical activity.
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Tension Free vaginal Taping (TVT):
• Through a small vaginal incision, permanent mesh-
like material is placed underneath the urethra and
anchored to the abdominal muscles above the pubic
bone.
• The mesh-like material remains as a permanent sling
under the urethra, preventing incontinence when
straining or coughing.
• General anesthesia or local anesthesia is required.
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• Less invasive, Small incisions- Local anesthesia
• Same day or overnight surgery stay
• Return to work in 2 - 3 weeks
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Transobturator Sling (TOT)
• The transobturator sling (tot sling) is subfascial, ie
the needle or the sling NEVER enters the retropubic
space.
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Complications:
• Difficulty urinating and incomplete emptying
of the bladder (urinary retention), although
this is usually temporary
• Urinary tract infection
• Difficult or painful intercourse
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Augmentation cystoplasty
• Augmentation cystoplasty is the most often
performed surgical procedure for severe urge
incontinence.
• In this surgery, a segment of the bowel is
added to the bladder to increase bladder size
and allow the bladder to store more urine.
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Augmentation cystoplasty
Contraindications
• Patients who are unable or unwilling to perform life-
long intermittent catheterization should not undergo
augmentation cystoplasty because of the high
likelihood of ultimately requiring catheterization.
• In addition, patients with inflammatory bowel
disease, bladder tumors, or severe renal insufficiency
should not undergo augmentation cystoplasty.
• Patients with a short life expectancy - consider
alternatives such as continued medical management.
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Ur et h r al B ul k i n g
Indications:
• Stress or Urge incontinence
• Poor or no response to conservative
management
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A i m of bul k i n g
• Build up the thickness of the wall of the
urethra so it seals tightly when you hold back
urine.
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• Performed under local anaesthesia
• Collagen used as bulking agent
• a skin test is done to check for allergies before
the procedure
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Risks:
• pain at the injection site
• injury to the urethra, and
• Migration/ dislodging of the bulking material
