Urinary Incontinence Surgeries

Too many women suffer silently from urinary incontinence, either embarrassed to get help or worried there’s nothing that can be done. We’re opening up the conversation and empowering women to take back their active lifestyles.

Urinary incontinence can result from pregnancy and childbirth or occur with aging. It’s not just a part of life women have to deal with. For many, urinary incontinence can be relieved or even cured without surgery.

But sometimes, natural and non-surgical methods just aren’t enough. For many women seeking that permanent fix, slings have played an amazing role in our treatment toolbox—a trend that continues through today. Urethral “Bulking” Injections provide a mesh-free approach to treating urinary incontinence. We believe in discussing your symptoms, goals, and full range of treatment options to create a best path forward towards a fuller life.

Do you have Stress Incontinence?

• Leakage of urine with coughing or sneezing
• Feeling wet after jumping, bending or squatting
• Sudden leaks during sports, for instance tennis, running, aerobics
• Leakage during intercourse

Your Surgical Options

Tension Free Sling: Improving Urinary Incontinence in as Fast as 15 Minutes

Sling operations are performed to correct stress urinary incontinence (leakage of urine with coughing, sneezing, physical exertion).  This procedure involves placing a synthetic mesh (“tape”) material underneath the mid portion of the urethra. The mesh normally should not be seen or felt, and is permanent.  

The outpatient procedure is performed in just 15 minutes, under local anesthesia through a very small vaginal incision, and patients go home 1-2 hours afterwards with a quick recovery. Midurethral (or tension free) sling procedures are specifically designed for women with Stress Urinary Incontinence (SUI) — meaning the accidental leakage of urine during coughing, sneezing, exercise and physical exertion. Sling procedures place support underneath the urethra, allowing it to compress shut during a cough, strain or other moment of stress. We’ve performed more than 10,000 midurethral sling (or tension free sling) procedures, with great success, for more than 20 years. In those two decades, a huge number of studies across the globe have demonstrated its effectiveness and very reasonable risk profile. 

In our experience, more than 90% of our patients report cure or significant improvement of their stress urinary incontinence. Satisfaction rates are very high, and significant complications are extremely rare. Slings certainly don’t fix every bladder problem that might arise during a woman’s adult lifetime, but if your goal is to get back to feeling confident when you’re exercising, running after the kids or grandkids, laughing or coughing, then a sling may certainly be something to learn more about.

Interested in more information on slings? Check out these patient information resources from the International Urogynecological Society (IUGA) and American Urogynecology Society (AUGS).

Urethral “Bulking” Injections: An Office-based, Mesh-free, Alternative for Stress Incontinence

If you’re looking to improve your control while avoiding surgery, this might be a great option. Urethral injections are performed in the office. In just a few minutes, the opening of the urethra is tightened to reduce stress urinary incontinence.

The procedure is performed with a catheter-sized camera (a cystoscope). A bulking material is gently injected into the wall of the urethra—not unlike collagen being injected into lips for cosmetic bulking—to create a better seal between the urethral walls. Urethral injections have been safely performed for over 15 years, and are minimally invasive with the ability to resume all normal activities after the office visit. If the injection is effective, you should notice an improvement right away. If the effect wears off, you can receive a booster injection.

Check out more details on urethral bulking injections here.

What’s with the Pelvic Mesh Controversy, and should it impact my surgery decisions?

Our center has a 20+ year history performing both non-mesh and mesh-reinforced surgical repairs. As a result, we have a high level of comfort in determining whether a surgery including mesh may be a good fit for an individual patient, or if it’s best avoided. Our goal isn’t to make a quick decision, or a pre-determined decision; it’s to investigate your problem, present the alternatives, and help you arrive at your decision. As part of this process, we believe it’s important that each patient is armed with accurate information. The information below is not intended to cover every aspect, or all details surrounding this topic; however we hope it will establish the framework for an open and informative discussion with your surgeon.  

First of all:  Don’t worry, mesh is never the only option!

Based on your specific pelvic floor condition, our physicians will always present a range of treatment options:  often including non-surgical therapies, surgical options involving no mesh (referred to as “native tissue”) and mesh-reinforced surgery. We feel it’s important that you understand the way mesh “fits” into our list of surgical options as you make your decisions. Mesh is never the only option, but in many cases it is worth strongly considering.

The role of mesh, and the controversy

We have been using mesh materials for more than two decades, and the  same open-weave, monofilament polypropylene mesh material has been the standard mesh material in our specialty since 1999. It is important to understand that mesh came into use within our specialty because of dissatisfaction with the results of prior techniques that repaired weak and damaged tissue with only sutures (stitches). While mesh for urinary incontinence became popularized around 2000 and remains the standard of care today, the major controversy arose over the use of mesh for pelvic organ prolapse repairs which entered the U.S. starting around 2007. These mesh kits for the repair of pelvic prolapse became the subject of significant controversy and legal activity.

This issue also created a great deal of internal controversy within our field, as there were surgeons who had been using certain mesh devices very successfully, and others who had been seeing significant complications following certain mesh procedures. In 2019, the FDA made a decision to force all prolapse mesh kits to be withdrawn from the market until / unless additional future studies are conducted. Therefore at the present time, the prolapse mesh kits that were the major focus of the debate are no longer in existence today. 

These days there are still two main uses for mesh in female pelvic reconstructive surgery, both of which are regarded as highly successful options for patients to consider. These include: (1) mesh slings for stress urinary incontinence, and (2) sacrocolpopexy mesh to repair pelvic organ prolapse, usually performed through laparoscopic or robotic-assisted techniques. Both of these mesh-reinforced surgeries have been available for decades with excellent rates of success, although we must always acknowledge that no surgery is 100% risk free. We believe every surgery should be individualized to the patient’s specific condition and treatment goals, to arrive at the least invasive and most effective treatment plan. 

Mesh Slings for Urinary Incontinence

Sling procedures for stress incontinence have gained huge popularity over the past decade due to high (>90%) rates of success and low complication rates, and having performed over 10,000 slings at our center, we have found complications in experienced hands to be extremely rare. In less than 2% of cases the mesh material may become exposed into the vagina, and in less than 1 in 500 cases the mesh may develop an “erosion” into the urethra or bladder. Other mesh-specific issues may include pain, abnormal scarring or improper positioning which could require another surgery. These conditions are rare, but when they occur they may require a repeat surgery. Although no procedure offers zero risk or a “100% guarantee”, we find the vast majority of women undergoing a sling for stress incontinence enjoy long-term success and an improved quality of life, and experience an easy and uncomplicated recovery.

 
This statement by the American Urogynecology Society (AUGS) was endorsed by two professional societies to add additional insight into the risks / benefits of mesh sling procedures, and to reinforce the safe track record of urinary incontinence slings when performed in experienced hands.