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Urinary Incontinence Surgery: Understanding the Options

By EmpowHER March 3, 2010 - 12:32pm

Women with urinary incontinence have a number of treatment options available to them including behavior modifications, medication, bulking agents and devices.

When other options fail, surgery remains an excellent treatment option for urinary incontinence. It is often required to remove blockages, change the position of the bladder, add bulk to tissues or add support to severely weakened pelvic muscles. In some cases, the urinary sphincter may be replaced with an artificial one.

Pubovaginal Fascial Slings 

Pubovaginal fascial slings are a highly successful option for women with incontinence. In this operation, the urogynecologist attaches a piece of fascia (flat, tough, tendonlike material — about 1 inch wide and 5 inches long) around the bladder neck to keep urine in, even under stress.

Mayo Clinic physicians report a success rate of over 90 percent using two types of pubovaginal fascial slings:

Autologous Sling: Made with fascia taken from the patient's body, usually from the lower abdominal area.

Cadaveric Sling: Made with fascia from a tissue bank, usually taken from the thigh of a tissue donor and carefully prepared and sterilized. If the fascial tissue is not treated properly, it can weaken and disintegrate.

Both types of surgery require two incisions: one through the vagina (approximately 2 inches) and one in the abdomen. For autologous slings, the abdominal incision is approximately 8 inches, while the cadaveric incision is less than an inch long. Women with serious health problems, those who cannot tolerate surgery, or those with urge incontinence alone may not be appropriate candidates.

Suburethral Slings

This is an outpatient, minimally invasive form of sling surgery with a high success rate. Instead of using human tissue to form the sling, suburethral slings are made of a synthetic mesh. The sling is placed under the urethra, where it acts as a hammock, compressing the urethra to prevent leaks that occur with activities of daily living.

Urinary Incontinence

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