Mild stress urinary incontinence may respond to pelvic floor physiotherapy. It is very important that patients have the opportunity to work with physiotherapists specialising in pelvic floor treatments and we work with a dedicated team who achieve excellent results.
If this fails, or for more severe symptoms, there are a number of very successful surgical treatments. These vary from day-case injection and vaginal tape procedures to more invasive colpo-suspension and autologous sling procedures. Your surgeon will discuss with you the options that may best suit your needs.
Injections of a hydrophilic bulking agent around the urethra can be a simple procedure to provide good relief of mild stress incontinence in younger patients and in particular those who are planning further children. It can provide several years of improvement before a more definitive procedure may be more suitable.
Vaginal Tape Procedures
These minimally invasive surgical procedures are by far the commonest surgical treatments offered for stress urinary continence. There are several varieties: the tension-free vaginal tape (TVT) and the trans-obturator tape (TOT) and the TVT-O are the most commonly used. In each a fine tape is inserted like a hammock under the urethra via a small incision in the vagina. The tape supports the urethra during coughing and exercise to prevent leakage of urine. The decision as to which procedure is performed depends on the individual anatomy. Success rates vary, between 82% and 96% of patients reporting freedom from stress incontinence.
Their popularity stems not only from the success rates, but also the simplicity of this day case procedure, and the ability of patients to return to normal activities within just a few weeks. The tapes are made of a non-absorbable inert polypropylene mesh which provides long-term support, but due to the nature of the vaginal tissues where the tape is placed, there is a small risk of tape migration or erosion. Your surgeon will discuss all the benefits and risks with you before a decision is made on the type of surgery.
For those patients not suitable for a tape, a colposuspension may be appropriate. For this procedure, an incision is made in the lower abdomen and sutures are passed to restore the position of the urethra by supporting the anterior vaginal wall firmly against the pelvic wall.
During this operation, a suprapubic incision is again made and a strip of the patient’s own fascia harvested from the abdominal wall. The strip of fascia is then placed as a ‘sling’ around the urethra and bladder neck through a separate small incision made in the front of the vagina.
In both these procedures, the need for an abdominal incision leads to a slightly longer recovery period before resuming normal physical activity.
The British Association of Urological Surgeons information leaflets for all these procedures can be downloaded as follows:
Pelvic floor exercises - www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/PFX_female14.pdf
Peri-urethral injections - www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Cysto_bulking14.pdf
Vaginal tape procedure - www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Sling_female.pdf
Colposuspension - www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Colposuspension14.pdf
Fascial Sling - www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Sling_autologous_female.pdf