Urinary Incontinence Surgery

Laparoscopic procedures are minimally invasive surgeries performed through small incisions in the abdomen. A thin camera (laparoscope) and specialized instruments are used to access the pelvic structures. This technique allows for:

• Precise repair of pelvic floor defects
• Suspension or reinforcement of the bladder neck or urethra
• Minimal tissue trauma and reduced bleeding

This approach accesses the pelvic organs through the vagina, avoiding external abdominal incisions. Transvaginal procedures often involve:

• Placement of supportive slings (e.g., mid-urethral slings) under the urethra
• Repair of vaginal wall defects
• Reinforcement of the bladder or rectum using sutures or mesh

Stress incontinence surgery includes sling procedures (creating urethral support) and bladder neck suspension. Slings use synthetic mesh, patient tissue, or donor/animal tissue. Tension-free slings utilize synthetic mesh tape without stitches, with retropubic, transobturator, and single-incision mini approaches. Recovery takes 2-4 weeks for strenuous activity and up to 6 weeks for sex. While safe and effective, mesh can cause complications. Conventional slings require vaginal and abdominal incisions, stitches, potentially a longer recovery, hospital stay, and catheter.

Bladder Neck Suspension surgery reinforces the urethra and bladder neck to prevent sagging and leakage. An abdominal incision allows the surgeon to place sutures near the bladder neck, securing them to a pubic bone ligament (Burch) or cartilage (Marshall-Marchetti-Krantz). This approach may be recommended during other abdominal surgeries for pelvic organ prolapse. Downsides include the abdominal incision, general or spinal anesthesia, several weeks of recovery, and potential need for a urinary catheter.