There are several surgical procedures for the various types of incontinence. These procedures are reserved for people who have tried conservative treatments without success and are healthy enough to undergo surgery. A general, regional, or local anesthesia will be given, depending on the extent of the procedure.

Procedures for Female Stress Urinary Incontinence

Retropubic Suspension —When the bladder or urethra has fallen out of place, this procedure is used to attach the tissue next to the bladder or urethra to the pelvis (bringing the bladder or urethra back to the correct position). The procedure is called Marshall-Marchetti when the vaginal tissue is attached to the back of the pubic bone. It is called a Burch procedure when the vaginal tissue is attached to the side of the pelvis. An incision is made in the lower abdomen so the sutures can be placed.

Pubovaginal Fascial Sling —The surgeon attaches a piece of tough, tendon-like material called fascia around the bladder neck to keep urine from leaking out. Two incisions are made—one through the vagina and one through the abdomen.

Suburethral Sling —When the urethra has fallen out of position or when the sphincter muscle of the urethra is weak, this procedure is used to place a sling under the urethra. The sling can be made from natural tissue or from man-made material. It acts as a hammock to support the neck of the bladder (where the urethra enters the bladder) and to prevent leaks. Some slings are attached to the pubic bone by stitches, while others are tied in front of the abdomen above the pubic bone. Sling procedures are performed through small incisions in the vagina and abdomen.

Newer Procedures —New, less invasive, safer suburethral sling procedures include tension-free vaginal tape (TVT) and transobturator tape (TOT). TVT is a mesh that is placed around the middle of the urethra. One small incision is made in the vagina, and two small incisions are made in the abdomen. TOT is a similar procedure that involves one small incision through the vagina under the urethra and one small incision in each thigh. Since the risks associated with an abdominal procedure are avoided, this approach might be safer in some cases.

Procedures for Male Urinary Incontinence

Male Sling —The surgeon places a strip of material under the urethra to provide support and to prevent the urethra from opening spontaneously. The ends of the strip are attached to the pelvic bone.

Artificial Sphincter —The procedure helps men who have persistent severe leakage, often after prostate surgery , as a result of nerve damage, or because of weak sphincter muscles. An artificial sphincter is a device that keeps the urethra closed until you are ready to urinate. A soft cuff is placed around the urethra to gently squeeze the urethra closed. A tiny pump is placed in the scrotum, which can be squeezed manually through the skin, transferring fluid into a small balloon reservoir in the abdomen. This allows urination to take place as the urine then flows through the urethra.

Sacral Nerve Stimulation

This procedure reduces urge incontinence. Surgery is performed to place a thin lead wire with a small electrode tip in the lower spine near the sacral nerve. A nerve stimulator continuously sends electronic impulses to the sacral nerve. This electronic stimulation therapy creates a bladder pacemaker, which reduces or eliminates urge incontinence.

Bulking Injections

When the sphincter muscle of the urethra is very weak, a substance called "bulking material" is injected into the tissues around the urethra. This causes the sphincter to become more narrow, and thus resistance to urine leakage increases. Bulking material is either organic collagen (a natural protein found in the body) or a man-made substance composed of small, carbon-coated, zirconium beads. This is a noninvasive surgical procedure that involves an injection, which can be performed in an outpatient setting under local anesthesia.

Bladder Augmentation

When the bladder is too small to hold the normal amount of urine produced by the kidneys, this complex reconstructive surgery can increase the size of the bladder and also its ability to stretch. A portion of the intestines or the stomach is attached to the bladder. General anesthesia is necessary, as a large incision is made in the abdomen. Oftentimes patients will need to continually use a catheter after the surgery to drain urine from the body.