Surgery
There are several treatment options available for stress urinary incontinence (SUI). These depend on the severity of symptoms, a woman’s age and general health, and whether she plans future pregnancies. Initial treatment usually involves pelvic floor muscle training, lifestyle changes, and trial of an incontinence pessary. When conservative treatments are unsuccessful, surgical options may be considered.
Surgical treatments include urethral bulking agents, such as Bulkamid, involve injecting a soft aquagel into the wall of the bladder neck to improve closure. Burch colposuspension is an abdominal operation that supports the bladder neck using stitches, and autologous fascial sling surgery, uses a strip of the woman’s own tissue to support the bladder neck. These procedures are effective but are more invasive and usually involve a longer recovery.
Mesh mid-urethral sling (MUS) surgery is a minimally invasive procedure developed in Europe in the 1990s and involves placing a narrow strip of polypropylene tape beneath the bladder neck to provide dynamic support during physical activity. MUS surgery has become the gold standard surgical treatment for stress urinary incontinence worldwide, due to its high success rates, short operating time, quicker recovery, and lower complication rates compared with more invasive traditional surgeries. It is the most extensively studied surgical treatment for SUI, with over 2,000 published scientific studies demonstrating its safety and effectiveness in the short, medium, and long term across a wide range of patient groups. Women considering surgery should have a detailed discussion with a trained specialist about the benefits and risks of all available options to support informed, shared decision-making.
CFI Position Statement on Mesh Mid-Urethral Slings
We are aware that many patients have concerns following international media reports about complications related to the use of mesh products for continence and prolapse surgery. The Continence Foundation of Ireland (CFI) was established by health professionals in Ireland who specialise in the treatment of incontinence and pelvic floor dysfunction. The aim of the CFI is to improve quality of life by raising awareness and providing clear, balanced, and evidence-based information.
The Continence Foundation of Ireland supports the use of mesh mid-urethral sling surgery for stress urinary incontinence when performed by appropriately trained clinicians, following careful patient assessment and informed consent. Based on the extensive international scientific evidence, CFI recognises mesh mid-urethral slings as a safe and effective treatment for appropriately selected women and considers them the current gold standard surgical option for SUI.
You may find the following links helpful.
www.yourpelvicfloor.org/media/Colposuspension_RV1.pdf
www.yourpelvicfloor.org/media/Fascial_Slings.pdf
www.yourpelvicfloor.org/media/mid-urethral-slings-RV4.pdf
www.yourpelvicfloor.org/media/Urethral_Bulking_RV1.pdf
www.bsug.org.uk/pages/information/guidelines/105
www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg35/
www.nice.org.uk/guidance/CG171
www.cochrane.org/CD006375/INCONT_mid-urethral-sling-operations-stress-urinary-incontinence-women
www.rcog.org.uk/en/news/rcog-and-bsug-response-to-nhs-england-mesh-report/
Overactive bladder (OAB) is a common condition characterised by urgency, frequency, and sometimes urgency urinary incontinence. Most people first try lifestyle measures, bladder training, and medications. If symptoms persist despite these treatments, there are effective surgical options available.Intravesical Botox (OnabotulinumtoxinA) is an injection of botulinum toxin into the bladder wall under local or general anaesthesia. It works by relaxing the bladder muscle, reducing urgency and leakage. Botox injections are usually performed as an outpatient procedure and can provide symptom relief for several months. The main side effects can include temporary difficulty emptying the bladder, which may require intermittent self-catheterisation, and an increased risk of urinary tract infections.
Sacral neuromodulation (SNM) is a minimally invasive procedure that uses a small implant to deliver electrical stimulation to the sacral nerves, which control bladder function. It is typically performed in two stages: a trial period to test response, followed by implantation of a permanent device if symptoms improve. SNM can significantly reduce urgency, frequency, and incontinence episodes. Risks may include pain at the implant site, infection, device movement, or the need for reprogramming or revision. A specialist will discuss the benefits, risks, and expected outcomes of these options to help you choose the most suitable treatment based on your symptoms and individual circumstances.
