Surgical Tratment of Urinary Incontinence
Surgery may be considered if conservative measures are unsuccessful. Only surgeon who has had specialist training in incontinence surgery should carry out the operation.
Tension Free Tape Vaginal operations
A piece of tape is inserted through an incision inside the vagina and threaded behind the urethra. The middle part of the tape supports the urethra, and the two ends are threaded through two incisions in either:
- the abdomen; this is called a retropubic tape procedure or tension-free vaginal tape procedure (TVT)
- the tops of the inner thigh; this is called a transobturator tape procedure (TOT)
Some studies have suggested that TVT may be more effective than TOT.
Bladder neck bulking injections
A bulking agent is injected into the walls of the urethra. This increases the size of the urethral walls and allows the urethra to stay closed. This is less invasive than other surgical treatments, as it does not require any incisions. However, it is less effective than the other options, and this effectiveness reduces with time.
Botulinum toxin A injections for urge incontinence
A new treatment for urge incontinence and overactive bladder (OAB) is injection of botulinum toxin A into the sides of the bladder.
The latest evidence suggests that this may cure incontinence or improve symptoms by 90%. The effects can last for up to 12 months.
However, after these injections, there is a risk that the patient may not be able to pass urine normally for some time, and so will need to insert a catheter (thin, flexible tube) to drain the urine from the bladder. The long-term effects of this treatment are not yet known, but it may be of benefit when other treatments have failed.