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What is Urinary Incontinence Surgery in Women?

Urinary incontinence surgery in women involves the repair or repositioning of the bladder to prevent the involuntary loss of urine. Urinary incontinence is a condition that occurs when a person is unable to control the flow of urine. This can lead to involuntary loss or leakage of urine when a person sneezes, coughs, or laughs. Urinary incontinence can also occur due to stress, injury, or genetic reasons.

What are the Causes of Urinary Incontinence in Women?

Girls or women may develop urinary incontinence due to the following reasons:

  • Pregnancy
  • Childbirth
  • Weak pelvic floor muscles
  • Pelvic organ prolapse
  • Overactive bladder muscles
  • Urinary tract infection
  • Vaginal infection
  • Obesity
  • Nerve damage due to diabetes or neurological disease such as Parkinson’s
  • Complications from a prior surgery such as hysterectomy

Pre-Surgical Preparation for Urinary Incontinence Surgery in Women

Before scheduling surgery for urinary incontinence, your surgeon will perform a thorough health check-up which includes a review of your medical history, physical examination, and assessment, as well as diagnostic laboratory reports. You will be given instructions to follow leading up to your surgery. These may include dietary restrictions and instructions regarding any medications you are taking. You are also advised to quit smoking and to perform regular exercise.

What is the Procedure for Urinary Incontinence Surgery in Women?

The steps involved in urinary incontinence surgery for women include:

  • You may be placed in the lithotomy position, a variation of the supine position with your legs placed apart and the knees slightly raised at a certain angle. The angles are determined by your surgeon at the time of surgery. Or your surgeon may also use the Trendelenburg position in which your head is placed at a lower angle than your feet.
  • An intravenous line or IV is started. You may be given antibiotics through the IV to decrease your chances of infection.
  • You may be administered a spinal or general anesthetic to induce sleep and block pain sensation.

There are 3 different types of surgery for the treatment of urinary incontinence in women. These include:

Open Abdominal Bladder Suspension or the Burch Technique for Bladder Repair:

In this procedure, a single incision is made in your abdomen, over your bladder.

  • Your surgeon then stitches the urethra and nearby bladder neck to the lining of the pelvic bone or other nearby structures.
  • By changing the location and angle of the urethra, urine has less tendency to flow easily under stress.
  • The incision is closed and covered with sterile surgical tape.

Laparoscopic Bladder Suspension for Urinary Incontinence in Women:

This is an alternative to open surgery.

  • In this procedure, a few tiny incisions are made in your abdomen.
  • A laparoscope, a thin viewing instrument, is inserted through one of the incisions.
  • Carbon dioxide gas may be pumped into the abdomen for better visualization of the organs and other structures through the laparoscope.
  • Miniature instruments are inserted through the other incisions to repair the bladder.
  • The urethra and the bladder neck are stitched to the lining of the pelvic bone or other nearby structures.
  • Once the bladder is repaired, the laparoscope and surgical instruments are removed.
  • The incisions are closed and covered with sterile surgical tape.

Sling Procedures: Vaginal Sling/ Urethral Sling for Bladder Repair

In a sling procedure for the treatment of urinary incontinence in women, your surgeon makes 2 small incisions – one in the vagina and the other in the abdomen.

  • The vaginal incision exposes the urethra and nearby bladder.
  • The abdominal incision exposes the tough piece of tissue near the cervix called the rectus fascia.
  • Your surgeon attaches one end of the sling, made of your own tissue or synthetic material, under the urethra and nearby bladder.
  • The other end of the sling is attached around the rectus fascia to form hammock-like structural support for the urethra.
  • At the end of the procedure, your surgeon sutures the incisions.
  • In most cases, a catheter is inserted to drain the bladder.

The duration of urinary incontinence surgery is 1 to 2 hours.

Post-Surgical Care after Urinary Incontinence Surgery in Women

After your urinary incontinence surgery, you will be taken to the recovery area for post-operative monitoring. Antibiotics, pain relievers, and other medications are available as necessary, and you may be required to stay in the hospital for 1-3 days if yours was an open surgery.

  • You may be allowed to return home the same day of your surgery if you underwent a laparoscopic procedure.
  • You can return to your normal activities in a few weeks, but complete recovery may take longer.
  • Walking is encouraged as soon as possible after the surgery. However, avoid strenuous exercises.

You should keep all follow-up visits with your surgeon to monitor your post-operative recovery.

What are the Risks and Complications of Urinary Incontinence Surgery in Women?

Some of the risks and complications associated with urinary incontinence surgery in women include:

  • Pain or difficulty during urination
  • Frequent urge to urinate
  • Weakness of the bladder or abdominal muscles
  • Loss of bladder control
  • Urinary tract infection
  • Painful sex
  • Side-effects of anesthesia such as nausea and vomiting
  • Chronic pelvic pain
  • Bladder or ureter injury

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