Urinary Incontinence

Surgery

When other options fail, surgery remains an excellent choice for treatment of urinary incontinence. It is often required to remove blockages, change the position of the bladder, add bulk to tissues or add support to severely weakened pelvic muscles. In some cases, the urinary sphincter may be replaced with an artificial one. Mayo Clinic specialists work with patients and families to select the most appropriate treatment.

Pubovaginal Fascial Slings

Pubovaginal fascial slings are a highly successful option for women with incontinence. In this operation, the urologist attaches a piece of fascia (flat, tough, tendonlike material — about 1 inch wide and 5 inches long) around the bladder neck to keep urine in, even under stress.

Mayo Clinic physicians report a success rate of over 90 percent using two types of pubovaginal fascial slings:

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Autologous Sling: Made with fascia taken from the patient's body, usually from the lower abdominal area.

Cadaveric Sling: Made with fascia from a tissue bank, usually taken from the thigh of a tissue donor and carefully prepared and sterilized. If the fascial tissue is not treated properly, it can weaken and disintegrate. To overcome this problem, Mayo doctors obtain cadaveric fascia from select companies that specialize in proper treatment of fascia tissue.

Both types of surgery require two incisions: one through the vagina (approximately 2 inches) and one in the abdomen. For autologous slings, the abdominal incision is approximately 8 inches, while the cadaveric incision is less than an inch long. Before this treatment is considered, Mayo Clinic surgeons spend substantial time with patients to evaluate its appropriateness. Women with serious health problems, those who cannot tolerate surgery, or those with urge incontinence alone may not be appropriate candidates.

Suburethral Slings

This is an outpatient, minimally invasive form of sling surgery with a high success rate. Instead of using human tissue to form the sling, suburethral slings are made of a synthetic mesh. The sling is placed under the urethra, where it acts as a hammock, compressing the urethra to prevent leaks that occur with activities of daily living. This procedure is less invasive (requires a smaller incision, resulting in less pain), has a faster recovery time and has the same rate of success as the pubovaginal sling surgery. Because of these benefits and Mayo specialists' high rate of success, the suburethral sling procedure is performed more often than the pubovaginal sling at Mayo Clinic.

Sacral Nerve Stimulation

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Sacral nerve stimulation is an FDA-approved electronic stimulation therapy which can be effective in reducing urge incontinence. A thin lead wire with a small electrode tip is surgically placed near the sacral nerve (in the lower spine), which controls voiding function. A nerve stimulator then sends small electrical impulses continuously to the sacral nerve. The impulses act as a bladder pacemaker, reducing or eliminating urge incontinence in a high percentage of patients.

Enlarging the Bladder

Using a segment of intestine to enlarge the size of the bladder, this surgery can cure incontinence. However, in up to 30 percent of cases, patients may need a catheter.

Laparoscopic Surgery

Mayo Clinic specialists are experienced in minimally invasive procedures using an endoscope, (laparoscopic surgery). These procedures are used to surgically remove urinary tract obstructions, such as kidney stones and enlarged prostate glands. The endoscope is a small, flexible tube with an attached optical system that is inserted into the body through the urethra or a small incision. The optical system allows physicians to see inside the body and perform surgery by inserting and manipulating equipment through the tube.

Mayo Clinic urologic surgeons in Arizona, Rochester and Jacksonville use robotic technology to increase precision and effectiveness of laparoscopic surgery.

Reoperation

Mayo Clinic surgeons are experienced in repairing previous surgeries that have failed. Mayo Clinic is also a regional referral center for patients with fistulas, holes in the bladder that may develop after a previous surgery.