Medical Opinions on the Safest Surgical Treatment of Stress Incontinence

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What is Stress Incontinence?

Stress incontinence is the involuntary loss of urine, which usually happens when stress is placed on the urethra. Common causes of this stress include exercise, laughing, and coughing. When the kidneys, nervous system and urinary tract function properly, the ability to hold urine and control elimination is not a hard task. The sphincter of the bladder surrounds the urethra and squeezes shut to keep urine from leaking out. The detrusor is a muscle inside the bladder wall that must stay relaxed so the bladder can fill with urine. With stress incontinence, the sphincter muscle and pelvic muscles that keep the bladder and urethra in place, become weak. This can occur due to injuries, surgery or medications.

Best and Safest Surgical Treatment of Stress Incontinence in Women

The TVT surgery is the safest surgical treatment of stress incontinence, as it uses a mesh tape to hold the urethra in place rather than cutting or stitching the urethra like other treatments. In women, the tape is inserted through incisions made in the abdomen and then also through cuts in the vaginal wall and no stitches are used to hold the tape in place. The entire surgery takes about a half an hour to complete and is done with only local anesthetics. This is done so that when the surgeon asks, the patient can cough to test the effectiveness of the procedure. For men, the surgery is also done through small incisions in the abdomen and the groin area. The entire procedure for both sexes is done in the same manner, but women need a longer recovery period than men.

Post Operation and Recovery

After the surgery, the patient is asked to urinate so that the bladder’s response and urethra can be tested. An overnight stay may be required, but the patient is often released from the hospital the same day of the procedure. While recovering at home, a catheter may be used to eliminate urine from the body, especially if the reaction of the bladder or urethra is reduced. This allows the body time to relearn how to urinate on command. The surgery causes very little pain or discomfort and recovery times are one to two weeks on average. There are restrictions on sexual activity and strenuous activity of six weeks and on driving for two weeks after surgery to prevent pressure on the surgical site.

It is thought that TVT is the safest surgical treatment of stress incontinence, especially on the obese patient. The risks involved during surgery include puncture of the bladder or a perforation. This risk is higher than that of any other treatments for stress incontinence, but with a cystoscopy, the bladder can be monitored to ensure safety.

Resources from the Incontinence & Overactive Bladder Health Center

MedLinePlus from the article Stress incontinence