Restore Your Freedom

Disorders of the pelvic floor are common with sufferers experiencing a loss of freedom and control

Surgery

Some causes of stress and other kinds of incontinence can be repaired by surgery. There are various procedures used by specialists with new ones being developed each year. Here are some:

Stress incontinence surgery

Colposuspension involves the suspension of the bladder neck, and is used for stress incontinence caused by slippage of the bladder. There are different types of surgery for this condition. In general the bladder is suspended with stitches at the pubic bone area to keep it in place. It can be done through a large cut made in the abdomen or through keyhole surgery.

Needle suspension aims to achieve the same result of colposuspension but uses a different technique. The bladder is suspended by a nylon thread that goes to the skin's surface.

Anterior vaginal repair is another type of correcting operation. It's done when the bladder and urethra have slipped into the vagina (prolapse) and need to be put back in place.

Vaginal sling is an operation to place strips of material under the bladder, the bladder neck and the urethra in a hammock-style arrangement. This helps support the bladder in its proper position. The strips can be made of different materials, both manmade and natural.

Tension-free vaginal tape (TVT) is a form of sling. The procedure is shorter and less invasive. The tape is inserted below the urethra, providing suspension and stabilisation of the bladder. The tape is inserted through the vagina and is wrapped around the urethra. Its suspension is established by securing it to your abdomen through small cuts. The surgeon doesn't pull the tape, which is why it's called tension-free. The scar tissue formed over the tape ends in your abdomen is enough to keep it in place.

Adjustable Continence Therapy (ACT) involves the implant of urethral balloons on either side of the urethra, close to the bladder neck. Fluid is used to fill the balloons which press on each side of the bladder neck to restrict the accidental flow of urine. A tubing system with a small port is placed under the skin allowing access for volume adjustments to enable individual alteration. Urination happens in a natural manner and no manipulation by the patient is needed. ACT is available for women for the treatment of stress incontinence and for men for post-prostatectomy incontinence.

Artificial sphincter is a device which works similarly to the balloons, providing external pressure by implanting a ring around the urethra that is filled with fluid. The ring is used to open and close the urethra by filling and emptying the fluid. To do that, a device is placed under the skin that controls the ring. During urination, the device is activated manually which then releases the pressure around the urethra by emptying the fluid from the ring, and then the urethra opens.

Urethral bulking agents or implants make use of injections of, for instance, your own fat cells or bovine collagen, to create more bulk around the urethral area. This helps the body keep the urethra and bladder opening closed. Natural bulking agents are reabsorbed into the body and wear off, decreasing durability of improvements and requiring repeat treatments. Synthetic bulking agents aren't reabsorbed into the body but long-term durability is generally low. The use of bulking agents is relatively new.

Botulinum Toxin injection is under investigation as a therapy for bladder problems but is not approved by health authorities or assessed by long-term studies. Botox (the same material that's used for cosmetic medicine) is injected into the bladder wall. Its goal is to block the chemicals that tell the bladder to contract and therefore relieve symptoms of overactive bladder syndrome.

Surgery for prostate gland enlargement

Prostate surgery for prostate enlargement (benign prostatic hyperplasia and benign prostatic hypertrophy) is when the enlarged prostate is surgically reduced in size or removed. This reduction or removal takes the pressure off the urethra allowing a better flow of urine. There are different surgical procedures to do this: surgically removing the obstructing part or all of the prostate is called transurethral resection of prostate (TURP).

Transurethral Needle Ablation Therapy (TUNA) is a minimally invasive procedure. Two needles are inserted into the prostate, heated by radiowaves which produce targeted thermal ablation (removal of tissue) inside the prostate.

Another similar therapy uses microwaves instead of radiowaves. It's called transurethral microwave therapy (TUMT).

More information can be found on our Prostate Health site.

Catheter

A catheter is a tube used to manually empty the bladder through the urethra or abdomen. Intermittent catheterisation is emptying of the bladder without a permanent catheter. Indwelling catheterisation is when the tube stays in the bladder for a longer period. A Foley catheter is a long-term device.

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