The document discusses various surgical management options for urinary incontinence. It describes approaches like retropubic colpo-suspension, pubovaginal slings, tension free vaginal tape (TVT), and transobturator tape (TOT) for stress incontinence. For urge incontinence, it discusses augmentation cystoplasty which involves adding a bowel segment to the bladder to increase its size. It also describes urethral bulking which involves injecting material to thicken the urethra wall and help it seal tightly. All procedures aim to recreate urethral support or increase bladder capacity to manage incontinence.

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Urinary Incontinence
SURGICAL MANAGEMENT

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B efor e t h e sur ger y:
• accurate diagnosis
• assessment by- incontinence specialist,
urologist or urogynecologist.
• For pre-natal women or women planning to
bear a child, doctors recommend holding off
the surgery- it may undo any surgical fixture.

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A i m of su r gi cal
m an agem en t :
• recreating urethral support allowing for the
normal functioning of the urethra during
increased abdominal pressures.

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A ppr oach es for St r ess
I n con t i n en ce
 Abdominal approaches
• Retropubic colpo-suspension
– Burch
– Marshall-Marchetti-Krantz (MMK)
 Contemporary
• Pubo-vaginal sling
• Tension free vaginal tape (TVT)
• Trans-obturator tape (TOT)

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Retropubic Colpo-suspension
• Retropubic suspension surgery is used to
treat urinary incontinence by lifting the
sagging bladder neck and urethra that have
dropped abnormally low in the pelvic area.

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Retropubic Colpo-suspension

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P u bo-vagi n al Sl i n gs
• The procedure involves placing a band of sling
material directly under the bladder neck (ie,
proximal urethra) or mid-urethra, which acts
as a physical support to prevent bladder neck
and urethral descent during physical activity.

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Tension Free vaginal Taping (TVT):
• Through a small vaginal incision, permanent mesh-
like material is placed underneath the urethra and
anchored to the abdominal muscles above the pubic
bone.
• The mesh-like material remains as a permanent sling
under the urethra, preventing incontinence when
straining or coughing.
• General anesthesia or local anesthesia is required.

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• Less invasive, Small incisions- Local anesthesia
• Same day or overnight surgery stay
• Return to work in 2 - 3 weeks

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Transobturator Sling (TOT)
• The transobturator sling (tot sling) is subfascial, ie
the needle or the sling NEVER enters the retropubic
space.

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Complications:
• Difficulty urinating and incomplete emptying
of the bladder (urinary retention), although
this is usually temporary
• Urinary tract infection
• Difficult or painful intercourse

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Approach for Urge incontinence:
Augmentation Cystoplasty
Aim: increase bladder size

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Augmentation cystoplasty
• Augmentation cystoplasty is the most often
performed surgical procedure for severe urge
incontinence.
• In this surgery, a segment of the bowel is
added to the bladder to increase bladder size
and allow the bladder to store more urine.

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Augmentation cystoplasty
Contraindications
• Patients who are unable or unwilling to perform life-
long intermittent catheterization should not undergo
augmentation cystoplasty because of the high
likelihood of ultimately requiring catheterization.
• In addition, patients with inflammatory bowel
disease, bladder tumors, or severe renal insufficiency
should not undergo augmentation cystoplasty.
• Patients with a short life expectancy - consider
alternatives such as continued medical management.

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Ur et h r al B ul k i n g
Indications:
• Stress or Urge incontinence
• Poor or no response to conservative
management

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A i m of bul k i n g
• Build up the thickness of the wall of the
urethra so it seals tightly when you hold back
urine.

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• Performed under local anaesthesia
• Collagen used as bulking agent
• a skin test is done to check for allergies before
the procedure

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Risks:
• pain at the injection site
• injury to the urethra, and
• Migration/ dislodging of the bulking material

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THANK YOU