Suspension procedures to treat stress incontinence

A bladder neck suspension reinforces your urethra and bladder neck so that they won't sag and provides something for the urethra to compress against to help prevent leakage.

To perform the procedure, your surgeon makes an incision in your lower abdomen. Through this incision, your surgeon places stitches (sutures) in the tissue near the bladder neck and secures the sutures to one of two places:

  • A ligament near your pubic bone (Burch procedure) or
  • Cartilage of the pubic bone (Marshall-Marchetti-Krantz procedure)

Your surgeon may recommend this surgical approach if you're also having another abdominal surgery at the same time, for instance to repair prolapse of other pelvic organs.

The downside of bladder neck suspension is that the procedure requires an abdominal incision, and you need general or spinal anesthesia. Recovery takes several weeks, and you may need to use a urinary catheter until you can urinate normally.

Nerve stimulation to treat overactive bladder

Certain procedures to treat overactive bladder involve stimulation — using small, electrical impulses — of the nerves that signal the need to urinate. Nerve stimulation may help with urge incontinence, but these procedures aren't effective for treating stress urinary incontinence.

Sacral nerve stimulation

In this procedure, your surgeon implants a small, pacemaker-like device under your skin, usually in your buttock. Attached to the device — called a stimulator — is a thin, electrode-tipped wire that carries electrical impulses to the sacral nerve. These electrical impulses block messages sent by an overactive bladder to your brain, telling it that you need to urinate.

Sacral nerve stimulation doesn't work for everyone. You can try it out first by wearing the stimulator externally, after the attached wire is placed under your skin in a minor surgical procedure. If the stimulator substantially improves your symptoms, then you can have it implanted.

Surgery to implant the stimulator is an outpatient procedure done in an operating room under local anesthesia and mild sedation. Your doctor can adjust the level of stimulation with a hand-held programmer, and you also have a control to use for adjustments. The stimulation doesn't cause pain and may improve or successfully treat urge incontinence and urgency frequency syndrome in people who haven't had success with medications or lifestyle changes.

Tibial nerve stimulation

An alternative to sacral nerve stimulation, tibial nerve stimulation is a procedure to stimulate a nerve in your leg (tibial nerve). The electrical stimulation travels along the tibial nerve to the spine, where it connects with the nerves that control the bladder.

Called percutaneous tibial nerve stimulation, the procedure involves placing a needle through the skin near the ankle to reach the tibial nerve. An electric impulse flows through the needle. The procedure takes about 30 minutes, and you start by having it done weekly for 12 weeks. Based on your response to the treatment, your doctor may recommend follow-up sessions at regular intervals to maintain the results.

Tibial nerve stimulation may be an option if you've tried other treatments without success and you don't want to have surgery.

One step at a time

Finding an effective remedy for urinary incontinence may take time, with several steps along the way. If a particular treatment approach isn't working for you, ask your doctor if there's another solution to your problem.

April 18, 2014 See more In-depth