Urinary Continence Surgery

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Surgery may be performed either through the vagina or the abdomen. The aim is to support the neck of the bladder to help prevent urine leaking when coughing etc.

Vaginal Operations
1. Tension free vaginal tape (TVT): in this procedure a small piece of soft plastic mesh is placed under the neck of the bladder beneath the vaginal skin. In addition to the vaginal incision 2 small cuts will be made on the abdominal wall to assist with placing the tape. Recovery usually takes 3 to 4 weeks and heavy lifting and sexual intercourse should be avoided for 4 to 6 weeks. For further information click here.
2. Tension free vaginal tape – Obturator (TVT-O): this procedure is a development from the original TVT. Mesh is placed under the neck of the bladder in a similar manner but is passed through the side of the pelvis as opposed to the front of the pelvis. Whilst there is an increased risk of leg pain post-operatively, other surgical complications are decreased. For further information click here.
3. Burch colposuspension involves opening the abdominal wall and placing sutures on either side of the vagina to lift and support the bladder neck. Although successful it is reserved for patients who are having an open procedure for another operation at the same time. Patients require a longer recovery than for the above techniques and the risks of surgical complications are similar.
4. Suburethral bulking injection: here bulking agents are injected around the bladder neck to help keep it closed under pressure from, for example, coughing. The bulking agents tend to break down over a period of months and symptoms may return. Therefore, this procedure is particularly useful for women who may still wish to have children. The other procedures listed above are not as suitable in this instance as pregnancy and vaginal delivery may reduce their longterm efficacy.

For further information regarding all these operations and some other alternatives visit here.