Surgery may be used to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success. Urodynamic testing seems to confirm that surgical restoration of vault prolapse can cure motor urge incontinence.
The procedure of choice for stress urinary incontinence in females is what is called a sling procedure. A sling usually consists of a synthetic mesh material in the shape of a narrow ribbon but sometimes a biomaterial (bovine or porcine) or the patients own tissue that is placed under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a backboard of support under the urethra.
The tension-free transvaginal tape(TVT) sling procedure treats urinary stress incontinence by positioning a polypropylene mesh tape underneath the urethra. The 20-minute outpatient procedure involves two miniature incisions and has an 86-95% cure rate. Complications, such as bladder perforation, can occur in the retropubic space if the procedure is not done correctly. This minimally invasive procedure is a common treatment for stress urinary incontinence.
The transobturator tape (TOT) sling procedure aims to eliminate stress urinary incontinence by providing support under the urethra. This minimally-invasive procedure eliminates retropubic needle passage and involves inserting a mesh tape under the urethra through three small incisions in the groin area. While the procedure has shown risks during its infancy, recent developments have increased the cure rate to 90%.
The mini-sling procedure also known as TVT-Secure. The reported short term cure rates of the TVT-Secure ranged from 67% to 83%.
The needleless sling is a single incision TOT. It is implanted via one unique incision. The needleless has approximately 136% more surface area than the mini sling, which may better support the pelvic floor and urethra, and no sharp instruments are required to implant the sling besides the scalpel used to make the incision, which may enhance patient comfort.
The readjustable sling consists of a standard synthetic mesh sling combined with sutures that attach to an implantable tensioning device that resides permanently under the skin in the abdominal wall. Once implanted, this Readjustable Mechanical External (REMEEX) device can be re-accessed under local anesthesia to fine tune the sling should incontinence reappear months or years after the initial surgery
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