If behavior modification and pelvic floor exercises don’t resolve the symptoms of stress incontinence or are not the preferred primary option for these symptoms, your doctor at NYU Langone’s Center for Female Pelvic Medicine may recommend surgery, which can cure the condition in most women. There are two main categories of surgery, and the kind that’s right for you depends on the type of incontinence and the severity of your symptoms.
If stress incontinence is so severe that it’s interfering with your daily life, you may be a good candidate for a surgical treatment. Doctors encourage women to put off surgery until after they are done having children, because additional pregnancies can cause urinary incontinence to return.
In a sling surgery, your doctor creates a hammock-like support for the urethra using a sling that is either synthetic or made from tissue from your body called fascia.
During a midurethral sling surgery, which is performed in the hospital using spinal or general anesthesia, your surgeon places a synthetic sling under and around the urethra to add support, thereby reducing or preventing urine leakage.
Typically, you go home the day of the procedure, and you should rest for a day or two before returning to your usual activities. You should avoid sexual intercourse and strenuous physical activity for at least three weeks while the urethra heals. Some women need a catheter temporarily to aid in urination after the surgery.
In a pubovaginal sling procedure, the surgeon makes a small incision in the abdomen or leg and retrieves tissue, called fascia, from below the skin to create a sling made of your own tissue. This sling is placed under and around the urethra to provide it with better support.
You may need a catheter temporarily to help you urinate after the surgery. Because of the incision, recovery may take longer than with a midurethral sling—typically about one to two weeks.
In retropubic suspension, which requires general anesthesia, the surgeon lifts the bladder neck—the area where the bladder and the urethra meet—up to a more supported position. The surgeon makes an incision—or, if it is done laparoscopically, several small incisions in the abdomen—and attaches the part of the vagina that is under the area of the bladder neck to the ligaments of the pubic bone. This allows the urethral sphincter muscles to close properly after urination, preventing leaks.
The procedure may involve an overnight hospital stay. When you return home, you should refrain from coughing, sexual intercourse, lifting anything heavier than 10 pounds, or straining during urination or bowel movements, which can put stress on sutures. A catheter is typically required to aid in urination for several days after this surgery.
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