Surgery for Incontinence
Surgery for incontinence is rarely necessary to treat overactive bladder. However, if your symptoms are seriously disrupting your quality of life and you have not responded to other treatments for incontinence, your doctor may recommend one of the following surgical procedures, depending on the type of urinary incontinence you have.
Sacral nerve stimulation
Sacral nerve stimulation involves surgically implanting a pacemaker-like device called a stimulator under the skin, usually in the buttocks. This device sends mild, electrical impulses to the nerves that control urination. This surgery for incontinence can be done as an outpatient procedure under local anesthesia and mild sedation. Once the device has been implanted, you will need to limit your physical activities (including sex) for three weeks or longer until your incisions heal completely. You will have a handheld control instrument you can use to adjust the level of stimulation. The stimulation is painless and can be highly successful for people who have not had success with medication or lifestyle changes.
Artificial urinary sphincter
An artificial urinary sphincter is a device, implanted during surgery, that is designed to prevent urinary leakage when the sphincter no longer functions. An artificial urinary sphincter consists of three parts that are filled with saline: an inflatable cuff that is placed around the urethra, a balloon that is put under the belly muscles, and a pump that is implanted in the scrotum. When the pump is turned on, fluid in the cuff runs into the balloon. This causes the urethra to open and urine can flow out of the bladder. Once urine leaves the bladder, the cuff automatically refills with fluid within 90 seconds and the urethra closes, which prevents urinary leakage.
The surgical procedure to implant an artificial urinary sphincter takes about 30 minutes, and men can expect to reach urinary continence about 6 to 8 weeks later. In fact, 85 to 97 percent of men who have had severe urinary incontinence after prostatectomy and who had an artificial urinary sphincter achieve little to no urine leakage. Eighty percent of men who have undergone artificial urinary sphincter surgery say their quality of life improved after receiving the device.
Although surgery for incontinence that involves implanting an artificial urinary sphincter is generally safe, side effects and complications can occur. These include blood clots in the legs, damage to the urethra or bladder, difficulty emptying the bladder, infection at the incision site, and a worsening of urinary incontinence. In some cases, the artificial urinary sphincter fails and needs to be replaced.
Male Suburethral Sling
A male suburethral sling is a device that is implanted during an outpatient surgical procedure. Men who have mild to moderate urinary incontinence associated with a weak sphincter typically are candidates for a male suburethral sling. A weak sphincter frequently occurs following prostatectomy or TURP.
If you and your doctor decide you need a suburethral sling, you will likely undergo urodynamic studies to measure your urinary tract function, as well as a 24-hour pad test to see how much urine you are leaking. Fasting from midnight before the day of this surgery for incontinence is required, and you will need to stop taking any medications that thin the blood, such as aspirin.
A suburethral sling is made of polypropylene mesh and is positioned under the bulbous urethra (which is why it is also called a bulbourethral sling) through a small incision in the groin. The sling raises the urethra and gently compresses it to reduce urine leakage. Most men recover completely from this surgery for incontinence within 4 to 6 weeks, during which time they should avoid heavy lifting. Men usually need to have a catheter until swelling subsides and can also expect some immediate postsurgical pain.
Placement of a suburethral sling does not guarantee complete elimination of urinary incontinence, as some men still experience leakage. Complications are rare but may include an inability to urinate, recurrent leakage, bleeding, infection, and erosion of the sling.
A cystoplasty, also known as bladder augmentation, is major abdominal surgery. It involves a surgeon using a piece of tissue from your stomach or intestines to enlarge your bladder. Many men require use of a catheter for the rest of their lives after the procedure. Once you leave the hospital, it typically takes six weeks or longer to return to a normal schedule. Bladder augmentation does not always cure overactive bladder.
The most common complication following cystoplasty is the formation of bladder or kidney stones, which occurs in 18 to 50 percent of patients. About 6 percent of men experience perforation, which is characterized by nausea, vomiting, fever, and distention of the abdomen. Perforation can be deadly, so men should seek immediate medical help if they experience these symptoms.
Following cystoplasty there is an increased risk for cancer. Although it typically takes about 20 years after surgery for any malignancy to appear, cancer can develop as early as 4 years after this surgery for incontinence. Another complication of cystoplasty is obstruction of the small bowel, which is seen in about 3 percent of patients.
In most cases, surgery for incontinence fails because of an incorrect diagnosis. Other reasons may include insufficient skill by the surgeon, additional causes of incontinence that were not apparent before the surgery, and problems with healing. Factors that can impact the success of surgery for incontinence include obesity, radiation therapy, older age, poor nutrition, strenuous physical activity, and having a chronic cough.