Bladder Problems and Incontinence
Surgical Management of Bladder Problems and Incontinence
Surgery for incontinence or bladder problems is usually indicated if conservative means have failed.
Conservative options include physiotherapy or medication for certain types of incontinence.
Minimally Invasive procedures include:
- Mid-urethral Tapes
- Injection of bulking agent into the neck of the bladder
- Botox treatment to the bladder
More major procedures include colposuspension which is carried out in a small minority of patients.
We also use a minor surgical procedure to investigate the bladder when symptoms are not easily explained or resistant to treatment. This is called cystoscopy.
Why see a Subspecialist Urogynaecologist?
An accredited subspecialist urogynaecologist has been trained to manage women with urinary problems to the highest level of expertise. They work at centres where patients from other units refer into with complex problems such as women who have previously been operated on or treated for urinary incontinence or prolapse without success. They also deal with women who have more than one type of incontinence or having incontinence as well as other pelvic floor problems such as prolapse of the vagina and uterus. Subspecialists are usually involved with training of surgeons, research and development of new techniques. This is the highest level of care that you can receive.
Conditions that can be treated surgically
- Stress Incontinence
- Urgency Incontinence/ Overactive Bladder Syndrome
- Mixed Urinary Incontinence (Both stress and urge incontinence)
Mid-urethral tapes are inserted around the urethra through the vagina. They have a high success rate (80-85%) and can last for over 15 years based on current evidence.
They are inserted using a minimally invasive technique through the vagina, in a procedure usually lasting between 15 and 30 minutes under general anaesthetic.
All procedures to restore continence can have an effect on the urinary flow, this is usually barely noticeable, but 3-5% of women do not empty their bladder successfully after the procedure. In almost all of these cases, the problem is reversible depending on the cause.
A woman might experience the feeling of needing to go to pass urine more frequently after any surgery to correct incontinence, this usually settles with time during the post-operative recovery period. Occasionally a woman might require treatment with medication to calm the bladder down.
In a small proportion of women, approximately 3-5%, the vaginal does not heal perfectly and requires re-stitching. This does not usually affect the benefits a patient receives from the original procedure.
Why choose a Mid-urethral Tape?
This procedure is recommended by the National Institute for Clinical Excellence (NICE), it is considered one of the gold standard procedures for treatment of stress urinary incontinence, and has a long record of evidence in the highest quality scientific studies of excellent success rates with minimal risks. It is a minimally invasive technique with only small incisions and therefore very little or no visible scarring. It should be inserted by a surgeon with appropriate level of training and workload to be able to perform the procedure competently and with minimal risk. (see NICE guidance in useful links below)
Injection of Bulking Agent into the Bladder Neck
This procedure involved injection an agent into the urethra around the bladder neck. It can be recommended in women who have other urinary problems as well as incontinence such as difficulties emptying the bladder. It is a technique that can also be used in more complex cases, such as women who have had previous continence operations. It is a short procedure, carried out under general anaesthetic and requires no incisions, or stitches. Women can typically go home the same day.
It does not have the same success rate or long lasting effects as a mid-urethral tape or colposuspension. It is usually recommended as a second line treatment currently based on available evidence.
- Difficulty emptying the bladder
- Urethral pain
- Urinary tract infection
The colposuspension is an older procedure for urinary incontinence. It has a good success rate and is carried out through an incision through the tummy, much like a caesarean section scar.
It requires a 45-60 minute procedure and a hospital stay of 3-4 nights, and a longer recovery time.
It is considered one of the gold standard procedures for incontinence but is less commonly employed because of the availability of the newer mid urethral tapes that have a shorter operating time, are less invasive, and have a quicker recovery time.
It is used by a subspecialist urogynaecologist if a previous continence operation has failed.
Colposuspension has the same risks as the mid-urethral tape, and further risks associated with being a more major procedure. There are no risks associated with vaginal healing because the procedure is not carried out through the vagina.
Click here to download more information regarding procedures for incontinence
This is a minor procedure that can be carried out as a day case procedure or under local anaesthetic in appropriate cases.
It involves passing a small camera into the water-pipe (urethra) and looking inside the bladder and urethra.
It is used to investigate the bladder commonly in the following cases:
- if there is any blood seen in the urine
- if incontinence has not responded to conventional treatment
- if there are symptoms of slow flow, poor emptying, or straining to pass urine
- to investigate pain in the bladder, vagina or pelvis
- to investigate repeated (recurrent) urinary infections or cystitis
Botox Treatment to the Bladder
If medication has failed to control an ‘unstable’ bladder, then you may be offered Botox treatment to the bladder.
This is short procedure that requires no incisions or stitches. It involves injecting Botox into the bladder wall via a camera called a cystoscope. You will be able to go home the same day after passing urine.
- Urinary tract infection
- Difficulties Emptying the Bladder
- Longevity: Botox treatment can last anywhere between 3 and 12 months and can be repeated when effects wear off. At the moment there is no good scientific data as to the long term effects of repeated Botox treatment.