female-urinary-incontinence-jpg.272

Leakage of urine due to physical pressure is known as stress urinary incontinence (SUI). Coughing, sneezing, jumping, or laughing can cause stress urinary incontinence.

Affecting about one-third of women, SUI can be nothing more than an irritant for few but a persistent medical condition for others, severe enough to impact the quality of life.

Evaluating Stress Urinary Incontinence

The most common cause of SUI is poor urethral support, also known as urethral hypermobility.

Heavy lifting or sneezing or coughing can result in increasing bladder pressure as well as throughout the abdomen. Poor pelvic support can result in the urethra opening, resulting in the urine leaking out.

Risk of stress urinary incontinence is more in women who have delivered vaginally more than once and older women.

urinary-incontinence-diagram-jpg.274

Another reason is intrinsic sphincter deficiency – inadequate closing of the sphincter muscles under pressure. This usually happens either due to injury while undergoing surgery or tissue atrophy or childbirth.

Treatment Options for SUI

SUI is treated by an urogynecologist who has specialization in the treatment of stress urinary incontinence.

There are three primary treatment options for treating SUI. They are:
  • Injections
  • Colposuspension
  • Urethral sling
Colposuspension and urethral slings are done via an abdominal incision, or vaginal incision or laparoscopy. Doctors might also give an injection to tissues around urethra.

Types of Urethral Slings

Two types of urethral slings are used for treating stress incontinence.

Midurethral sling

This is one of the most common types of surgery for treating SUI. A narrow synthetic mesh sling is placed under your urethra and acts as a support for the bladder neck and urethra.

mid-urethral-sling-surgery-jpg.273

Traditional sling

In this, a strip of your tissue is taken from either the thigh or lower abdomen. An abdominal incision is used to stitch the ends into place.

Midurethral Sling Procedures

There are two types of mid-urethral sling procedures
  • Retropubic (TVT)
  • Transobturator (TOT)

Retropubic technique

Also known as TVT (tension-free vaginal tape), a retropubic midurethral sling was the first procedure that was introduced to treat stress urinary incontinence.

First introduced in 1996, the TVT technique utilizes a mesh made from polypropylene. It is inserted through a vagina incision using a trocar.

The polypropylene mesh is positioned both under and around the urethra in a U shape.

The ends of the mesh are guided up between pubic bone and the bladder and brought out with the help of tiny abdominal incisions made above the pubic bone.

This is a partially blind technique, which means that the surgeon does not have a clear picture of the needle all the time. This makes familiarization of female anatomy a must.

Suprapubic arch or SPARC is another retropubic procedure technique, where the needle is inserted into the body in a top-down approach, entering above the pubic bone and exiting the body through the vagina.

To ensure that the tape has adequate tension, your doctor might ask you to cough (you are semi-awake in this procedure). If there is any leakage, the sling is tightened.

You maybe asked to cough again, and your surgeon makes adjustments to the sling as appropriate.

Once the sling is adjusted, the tape ends are cut below the skin. Before completing the surgery, the surgeon checks for bladder perforation with the help of cystoscopy.

Transobturator technique

Developed in 2001, the transobturator technique or TOT is safer than TVT and minimizes risk of bladder injuries. It is more reliable because it does not utilize spaces between the bladder and the pubic bone.

Instead, the strip is inserted into the body through a vagina incision and the ends are brought out with the help of tiny incisions made between labia and the creases present in the thigh.

The shape of TOT is like that of a smile, unlike the “U” shape of TVT. As with TVT, your surgeon adjusts the sling for any leakage and utilizes cystoscopy for checking the bladder.

Cure Rates

TVT cure rates range between 65% and 95%, with a 90% cure rate even after several years of the procedure.

Even though there is a lack of long term data for the transobturator technique, it is still effective as TVT, as shown in controlled studies.

In Conclusion

Miduretheral sling procedure is one of the best procedures for treating stress urinary incontinence.

You can return to usual activities within a few days after the procedure, but any heavy lifting, strenuous exercise, and sexual activity should be avoided for at least a month.