Surgical Incontinence Treatment

Trans – vaginal tape (TVT) or Trans – obturator tape (TOT)

• This is a quick operation that has replaced traditional sling surgery for stress incontinence in women. It involves inserting a mesh tape either through the vagina to the supra-pubic area (TVT) or through the groin into the vagina (TOT). The tape sits just below the midpoint of the urethra and if the woman coughs, sneezes or does anything that would normally provoke a stress type urinary leak, the tape tightens against the urethra and prevents leakage. Recovery time is very quick; most women go home the day after the procedure. The operation is usually very successful but, as with all operations, does carry some risk, for example, difficulty passing urine post operatively. Sometimes, intermittent self-catheterisation (ISC) is taught as a precaution prior to this procedure

Botulinium toxin (Botox)

• A new and exciting treatment for people with severe urinary urgency and frequency. The procedure is usually done as a day case and involves Botulinum Toxin being injected from a cystoscope through the bladder wall into the bladder muscle. This has the effect of paralysing the bladder muscle, therefore eliminating the feelings of urgency and usually works for about 9 months, when the procedure can then be repeated. Sometimes, following Botox treatment, a period of ISC is needed as the bladder may no longer empty properly. However, this period of ISC is often preferable for people who have previously had desperate urgency and urge incontinence. Usually the surgeon will ensure that the person is able to self-catheterise before going ahead with the procedure

Artificial urinary sphincter (AUS)

• Sometimes offered to people who have a very weak or damaged urethral sphincter. It involves inserting a silicone cuff around the urethra and a control device to enable the user to switch it in to store or empty mode. The surgery can be very successful for some people, but is prone to complications and the AUS needs replacing about every 10 years

Sacral nerve stimulation

• A surgical procedure for people with severe chronic overactive bladder or chronic neurogenic retention of urine. This operation is only done at specialist centres and involves inserting electrodes into the nerves of the sacral vertebrae which are stimulated by a pulse generator usually implanted in the buttock; this modulates the nervous pathways to the bladder

Trans – urethral resection of the prostate (TURP )

• An instrument is passed along the urethra to the prostate gland and the enlarged prostate is pared away from inside the urethra, a bit like coring an apple. For more severe prostate problems, such as prostate cancer, Radical Prostatectomy (the complete removal of the prostate gland) may be recommended instead