Most surgical procedures to treat stress incontinence fall into two main categories: sling procedures and urethral bulking agents.
During a sling procedure, your surgeon uses strips of synthetic mesh or your own tissue to create a sling or “hammock” under your urethra or bladder neck. The bladder neck is the area of thickened muscle where the bladder connects to the urethra — the tube that carries urine from the bladder. The sling supports the urethra and helps keep it closed — especially when you cough or sneeze — so that you don’t leak urine.
Bulking agents are injectable material for treating adult female stress urinary incontinence primarily due to intrinsic sphincter deficiency. A cystoscope is used to inject the material into the tissues surrounding the urethra. The increased “bulk” allows the urethra to close more effectively and prevents urine from leaking out. This is a less invasive option than sling surgery.
Surgical treatment of urinary urge incontinence is considered third line therapy which means that more conservative treatments and medications have not significantly improved symptoms. Options include Botox injection into the bladder muscle and sacral neuromodulation.
Botox is an approved treatment for OAB that’s delivered via injection. It works by blocking the muscles and nerves that lead to a feeling of urgently needing to urinate. If your doctor recommends Botox treatment for you, it is likely you’ll receive the treatment in your doctor’s office. The injection procedure is short and well-tolerated by most people. It’s effects can last several months, but you will likely need subsequent treatments to maintain symptom control.
Sacral Neuromodulation is delivered via the InterStim system. This implantable system sends electrical pulses to an area near the sacral nerve to modulate the neural activity that influences the behavior of the pelvic floor, lower urinary track, urinary and anal sphincters, and colon. Unlike oral medications that target the muscular component of bladder control, Sacral Neuromodulation offers control of symptoms through direct modulation of the nerve activity. A distinct advantage of Sacral Neuromodulation is that it is tested for potential success prior to moving on to long-term therapy. The evaluation gives patients and physicians an opportunity to find out in 7 days whether adequate symptom reduction is achieved. It is typically done as an outpatient procedure.