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Stress urinary incontinence (shortly referred to as SUI) is a type of urinary incontinence that occurs when intra-abdominal pressure increases such as coughing, sneezing, laughing, jumping. SUI is thought to occur as a result of weakening of the bladder’s supporting structures by stretching during birth, aging, or other conditions. It is caused by injury to the pelvic floor muscles or the fascia tissue, which is made up of collagen under the bladder and urethra.
Traditionally, the treatment of SUI is surgery. Although women with SUI try first with lifestyle changes, exercise, weight loss, or devices such as a pessary inserted into the vagina to support the bladder, these options do not work in most cases. Although there is a very effective alternative treatment option such as laser today, the surgical treatment of SUI will be discussed in this article.
Surgery may provide a long-term solution for women with stress urinary incontinence when other conservative treatments have not worked.
It should be kept in mind that surgery will not work in types other than stress urinary incontinence and there are different treatment methods in those types In stress urinary incontinence, the sudden pressure on the bladder suddenly changes the natural angle of the urethra and bladder neck, causing urine to escape from the bladder. The occlusive muscle group called the external urethral sphincter cannot function in this angle change and sudden pressure increase, and urine leakage occurs. The purpose of urinary incontinence surgery is to correct the deteriorated angle by supporting the urethra and bladder neck from below. This extra support helps keep the urethra closed when it encounters pressure so there is no urine leakage.
As with any surgery, urinary incontinence surgery has risks. Although rare, temporary urination difficulty, temporary difficulty in emptying the bladder (urinary retention), development of overactive bladder, urinary tract infection and some similar rare undesirable conditions may occur.
It is very important to make a correct diagnosis before deciding on surgery. Because different types of incontinence require different treatments. Your doctor recommends this surgery only when he/she detects stress type urinary incontinence. The first step in the treatment of other types or mixed types may be medication or some special exercises. Remember that stress incontinence surgery does not treat an overactive bladder with a sudden, severe urge to urinate. If you have mixed incontinence, which is a combination of stress urinary incontinence and overactive bladder, you will likely need additional treatments.
The pressure of pregnancy and childbirth on the bladder, urethra, and supporting tissues can negate the benefits of surgical correction. Therefore, if you are planning to have children, your doctor may recommend that you wait for surgery until your childbearing is over.
The most common type of urinary incontinence surgery is ‘suspension surgery’. Sling surgery uses a sling made of a synthetic material to support the urethra or bladder neck. These materials, called tension-free slings, are usually a mesh made from a synthetic material called polypropylene. The sling functions like a hammock to support the urethra.
Several different types of hangers can be applied. In the retropubic method, a small incision is made inside the vagina to access the urethra. There are also two small incisions on the pubic bone, just to the right and left of the middle. With long and special angled needles (guide needle), it is directed to the groin by passing both ends of the sling through the holes in the vagina and is removed onto the skin through the incisions made in the groin. The sling material is held in place by adhering to the soft tissue along its path. Cuts in the vagina and cuts in the skin are repaired with absorbable sutures. In the transobturator method, small incisions are made in the vagina, right and left groin. The surgical procedure is similar to the retropubic approach, except that the mesh passes through the groin muscles and not the abdominal wall. Both retropubic and transobturator methods are quite safe and effective. Another tension-free hanger type is the single-cut mini-hanger method. A single small incision is made in the vagina. A small mesh hammock is hung on the thigh muscles or other tissues in the pelvic area. The results of the single-incision mini-sling method are generally less effective, and more research is needed to determine the safety and effectiveness of this method.
The oldest and most traditional method is the Burch procedure. In this method, which is performed via the abdomen, one end of the surgical threads is attached to the outer wall of the vagina and the other end to the ligaments near the top of the pelvic bone. The stitches essentially suspend the vagina to the pelvic ligament, and when the stitches are tightened, the vagina is suspended up, supporting the bladder neck from below. Burch surgery is generally performed in cases where another operation will be performed in the abdomen (such as removing the uterus). Sometimes, laparoscopic surgery can be done by opening only a few holes without cutting the abdomen.
The time you spend in the hospital and the recovery process after urinary incontinence surgery vary depending on what type of surgery you had. In general, recovery is very fast in all types of surgery in this group. Sometimes, however, urination difficulties or inability to void may occur due to edema in the urinary tract after surgery. In such a case, you can be discharged from the hospital with a urinary catheter. After the edema passes in a few days, there is no problem and the catheter is withdrawn.
If your job is not strenuous and physical, you can return to work in a few weeks. You can start sexual activity after 6 weeks.