• Posted February 21, 2024

Which Surgery for Stress Urinary Incontinence Is Best for You?

If you're female and you lose bladder control upon exertion -- sneezing, coughing, laughing, lifting something heavy -- you may have stress urinary incontinence.

As many women know, the condition is no joke and it may keep you from doing the things you love.

There are solutions, however, some of them surgical. Here, experts at the Mayo Clinic and NYU Langone Health describe the various surgical options.

First of all, know there are pros and cons to choosing surgery to fix stress urinary incontinence.

Surgeries work by strengthening and supporting the urethra (the tube that directs urine out of the bladder) and the bladder neck (a muscle group located at the point where the urethra meets the bladder).

Using surgery to support this area helps the urethra stay closed when its under stress, so you don't leak urine.

"Although surgery has a higher risk of complications than other therapies, it may provide a long-term solution," noted experts at the Mayo Clinic.

A careful weighing of the risks and benefits of each surgical approach, along with your personal health factors and goals, is key to your decision.

The various forms of stress incontinence surgery include:

Sling surgeries. In this procedure, "your doctor creates a hammock-like support for the urethra using a sling that is either synthetic or made from tissue from your body called fascia," explained experts at NYU Langone Health.

There are different types of sling surgeries:

Tension-free sling surgery. In this approach, surgeons implant a sling made from a synthetic material that cradles and supports the urethra. It's typically held in place by the body's own tissues, Mayo Clinic experts explained. As patients heal, scar tissue forms that can hold the sling in place.

Tension-free slings are typically inserted in two ways.

In one approach, called retropubic, "the surgeon makes a small cut [incision] inside the vagina to have access to the urethra," Mayo Clinic experts explained. "There are also two small incisions above the pubic bone, just to the right and left of the center. The surgeon uses a needle to pass each end of the sling from the vagina to abdomen. The sling is held in place by the soft tissue along its path. Absorbable stitches close the vaginal incision, and the incisions on the skin may be sealed with glue or stitches."

A second approach, called the transobturator procedure, is similar to the retropubic procedure but the "mesh [sling] passes through the groin muscles rather than the abdominal wall," the Mayo Clinic explained.

There's also a third strategy to insert supportive slings, called the single-incision mini-procedure. The approach involves fewer incisions, but its effectiveness compared to other methods remains unclear, the Mayo Clinic noted.

If you've already had a sling procedure but still experience stress urinary incontinence, doctors may order what's known as a "conventional" sling procedure. This operation involves larger incisions and longer stays in the hospital, so it's usually a secondary surgical option.

Suspension procedures

According to experts at NYU Langone Health, in these operations "the surgeon lifts the bladder neck -- the area where the bladder and the urethra meet -- up to a more supported position. The surgeon makes an incision -- or, if it is done laparoscopically, several small incisions in the abdomen -- and attaches the part of the vagina that is under the area of the bladder neck to the ligaments of the pubic bone. This allows the urethral sphincter muscles to close properly after urination, preventing leaks."

The downside to these procedures is that they typically require general anesthesia and at least an overnight hospital stay. Patients are advised to avoid typical urinary stressors (coughing, sex, lifting heavy objects) for a while, and "a catheter is typically required to aid in urination for several days after this surgery," the NYU experts said.

Risks and Limitations

As the Mayo Clinic notes, stress incontinence surgeries do come with risks, including temporary trouble with urinating, overactive bladder, urinary tract infections, wound (surgical site) infections, difficult or painful sex, surgical material invading the vagina and groin pain.

There are also reasons to forgo these surgeries, most notably plans to have children.

"Your doctor might recommend waiting for surgery until you're finished with childbearing," the Mayo Clinic noted. "The strain of pregnancy and delivery on your bladder, urethra and supportive tissues might undo the benefits of a surgical fix."

The same experts noted that surgeries to fix stress urinary incontinence won't help with other urinary issues. So, for example, if you also have overactive bladder, that might require another treatment, they said.

SOURCES: Mayo Clinic, NYU Langone Health

What This Means for You

If you have stress urinary incontinence, there are numerous types of surgeries that might help.