What surgical treatments are available for stress incontinence?
If the incontinence is thought to be related to prolapse, vaginal repair surgery (6) will improve the problem in about 80% of patients. Some surgeons, particularly bladder specialists, may operate through the abdomen rather than the vagina. Stitches are introduced to either side of the urethra and attached to the ligaments or bone at the front of the pelvis (colposuspension). Injections of inert substances can be introduced under the bladder neck. Although with training they are said to be simple to introduce, they are not quite so simple to remove should there be problems. If there is true incontinence associated with a hole in the system (fistula) a urologist (bladder specialist) is likely to be able to close this defect.
For many years a variety of meshes have been introduced under the urethra with varying degrees of success. In the late 90s a simple technique - tension free vaginal tape (TVT) was introduced. A small incision is made under the urethra and the tape is inserted. Some surgeons perform the operation under local anaesthetic. Usually, you can go home the same day.
There are a variety of mechanical aids that put additional pressure on the bladder neck. They are designed to be easy to introduce and remove.
Related Medical Abstracts - Click on the paper title:-
- A prospective trial comparing tension-free vaginal tape and transobturator vaginal tape inside-out for the surgical treatment of female stress urinary incontinence: 1-year followup. (2007-01)
- Comparative analysis of urinary incontinence severity after autologous fascia pubovaginal sling, pubovaginal sling and tension-free vaginal tape. (2007-02)
- Retropubic compared with transobturator tape placement in treatment of urinary incontinence: a randomized controlled trial. (2007-03)
- Assessment of TVT efficacy in the management of patients with genuine stress incontinence with the use of epidural vs intravenous anesthesia. (2007-04)
- A cost-effectiveness analysis of tension-free vaginal tape versus laparoscopic mesh colposuspension for primary female stress incontinence. (2006-01)
- Laparoscopic colposuspension and tension-free vaginal tape: a systematic review. (2006-02)
- Outcome of tension-free vaginal tape procedure when complicated by intraoperative cystotomy. (2006-03)
- Quality of life and continence 1 year after the tension-free vaginal tape operation.(2006-04)
- One-Year Follow-up of Tension-free Vaginal Tape (TVT) and Trans-obturator Suburethral Tape from Inside to Outside (TVT-O) for Surgical Treatment of Female Stress Urinary Incontinence: A Prospective Randomised Trial. (2006-05)
- Result of the tension-free vaginal tape in patients with concomitant prolapse surgery: a 2-year follow-up study. An analysis from the Netherlands TVT database. (2006-06)
- Long-term results of tension-free vaginal tape (TVT) for the treatment of female urinary stress incontinence. (2006-07)
- A randomized controlled e quivalence trial of short-term complications and efficacy of tension-free vaginal tape and suprapubic urethral support sling for treating stress incontinence. (2006-08)
- The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. (2006-09)
- A review of the tension-free vaginal tape procedure: outcomes, complications, and theories.(2001)
Please click on the required question.
- 1 How is urine produced?
- 2 What is cystitis?
- 3 How prevalent is cystitis?
- 4 What is honeymoon cystitis?
- 5 What are Frequency and nocturia?
- 6 How prevalent are Frequency and nocturia?
- 7 What is urinary incontinence?
- 8 What is stress incontinence of urine?
- 9 What is urgency, urge incontinence and the urge syndrome?
- 10 What causes stress and urge incontinence?
- 11 What is dribbling incontinence?
- 12 How prevalent is urinary incontinence?
- 13 What is the urethral syndrome?
- 14 How can I record my bladder problems and monitor the effects of treatment?
- 15 What simple measures are available to reduce urinary incontinence?
- 16 What are pelvic floor exercises?
- 17 How successful are pelvic floor exercises?
- 18 What is bladder training?
- 19 How effective is bladder training?
- 20 Are there any alternatives to bladder training for urgency symptoms?
- 21 If simple measures do not suffice, what else is available for the treatment of urinary stress incontinence?
- 22 What are urodynamic studies?
- 23 Where can I obtain further information about bladder problems?
- 24 Support Groups.
Thank you for choosing to visit us.
This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
