Fifty years of surgical attempts to treat incontinence, especially in women, has resulted in three types of surgery. Depending on the underlying cause of the urinary incontinence, North Shore-LIJ urogynecologists will recommend the appropriate treatment.
The inability to hold urine has two causes. One has to do with support for the urethra and bladder, known as genuine stress incontinence (GSI), and the other is related to the inability of sphincter muscles, or intrinsic sphincter deficiency (ISD), to keep the opening of the bladder closed.
In GSI, weak muscles supporting the urethra allow it to move into the pelvic floor and create cystoceles, or pockets. The goal of surgery for GSI is to stabilize the pelvic floor connective tissues to prevent the urethra from moving too much when there is increased abdominal pressure (such as when sneezing, laughing, coughing or exercising).
The other major source of stress incontinence is due to weakening of the internal muscles of the sphincter, as they affect closure of the bladder. These muscles, called the intrinsic sphincter muscles, regulate the opening and closing of the bladder when a decision is made to urinate. Weak intrinsic sphincter muscles allow the opening to remain open and thus lead to chronic incontinence. ISD is a source of severe stress incontinence and may be combined with urethral hypermobility.
Most surgeries for stress incontinence fall into one of these two surgeries and their variants:
- Burch procedure, which stabilizes the urethra in a neutral position.
- Sling procedure, which uses tissue to undergird the urethra and put pressure on the sphincter.
Needle neck bladder suspension, which attaches the urethra neck to the posterior pelvic wall through the vagina or abdomen in order to stabilize the urethra, also can be performed in certain situations.
Information provided by www.surgery.com .