Urinary incontinence is a disruptive condition that can erode not only a woman’s confidence but also her sense of well-being and quality of life. The constant worry about unexpected leaks can make a woman second-guess her everyday activities or avoid them altogether, leaving her feeling isolated or frustrated.
Fortunately, there are a number of effective treatment options available for urinary continence. If yours has not improved with conservative treatments like pelvic floor exercises and medications, surgical intervention may be a dependable solution.
Among the most commonly performed surgeries for urinary incontinence are mid-urethral sling procedures, autologous fascial sling surgery, and Burch colposuspension. While these procedures differ in technique, they share the same goal: to provide support to the urethra and bladder neck, thereby preventing urine leakage and ultimately helping women regain a sense of normalcy. Here is a breakdown of how these procedures work and what to expect from each.
1. Mid-Urethral Sling Procedures
Mid-urethral sling surgery is considered the gold standard for treating stress urinary incontinence in women. It involves placing a narrow strip of mesh under the urethra to provide support during physical activities that can trigger leakage.
How It Works
The sling serves as a backboard for the urethra, keeping it shut when abdominal pressure increases (from coughing, laughing, etc.).
This procedure is typically performed using one of three distinct approaches:
- Retropubic approach – This method involves passing the sling behind the pubic bone through small incisions in the lower abdomen and vaginal wall. The sling comes out just above the pubic bone, where it forms a supportive structure beneath the urethra, similar to a hammock.
This approach offers strong support, making it particularly effective for women with more severe stress incontinence. However, because it traverses the space behind the pubic bone, there is a slightly higher risk of bladder injury compared to other techniques.
- Transobturator approach – With this approach, the sling is passed through a small opening in the pelvic bones near the groin, called the obturator foramen. This is done through small incisions in the inner thigh or groin crease, along with a vaginal incision.
This method avoids the space behind the pubic bone, reducing the risk of bladder or bowel injury. It provides excellent support and is often associated with less postoperative pain and a quicker recovery for many women.
- Single-incision approach – This technique involves placing the sling through a single
all vaginal incision. Unlike other methods, it does not pass through the groin area. Instead, specialized anchors secure the sling to the pelvic wall tissue on both sides, providing the necessary support to the urethra with less overall tissue disruption.
Effectiveness and Recovery
The procedure has a remarkable success rate, with up to 90% of women experiencing long-term improvement. Recovery from a mid-urethral sling procedure is typically quick and straightforward: many women resume light activities in as little as a week.
2. Autologous Fascial Sling Surgery
Autologous fascial sling surgery is similar in concept to sling surgery. The difference lies in the material involved, in that instead of a synthetic mesh, the procedure uses the patient’s own tissue, thus the term “autologous.”
Autologous fascial sling surgery is typically reserved for complex cases or individuals who have had complications with synthetic materials.
How It Works
During this procedure, a urogynecologist carefully harvests the patient’s own tissue from the lower abdomen (rectus fascia) or inner thigh (fascia lata). The doctor then shapes and reinforces the tissue to function as a supportive sling beneath the urethra, mimicking the role of synthetic mesh slings.
Effectiveness and Recovery
Success rates are comparable to those of synthetic slings but with a slightly longer recovery period, as it involves tissue harvesting.
3. Burch Colposuspension
This surgical method predates the popularity of sling procedures but remains highly effective for stress urinary incontinence. It is a preferred option among women for whom sling surgery is contraindicated or those who want to avoid the use of vaginal mesh, mainly due to concerns about potential complications linked to placing synthetic materials in the body.
How It Works
During the procedure, a urogynecologist lifts and secures the tissues around the bladder neck and urethra by placing permanent sutures in the vaginal wall, on either side of the urethra. These sutures are then attached to strong ligaments located near the pubic bone, effectively elevating and stabilizing the bladder neck.
Effectiveness and Recovery
This procedure has a strong track record, with success rates ranging between 70% and 90%. Though slightly more invasive than other types of surgeries for urinary incontinence, Burch colposuspension has lasting benefits. Recovery typically involves a short hospital stay, with most women able to resume normal activities within 4 to 6 weeks.
Because it repositions and reinforces the support structures rather than introducing foreign materials to the body, Burch colposuspension appeals to women seeking a natural and sustainable solution.
Surgeries for Urinary Incontinence in Syracuse, NY
If conservative treatments no longer provide adequate relief for your urinary incontinence, schedule a consultation with us here at University OB/GYN Associates.
We are proud to have OB/GYN experts on our team who specialize in treating women with bladder control issues (urinary incontinence), dropped uterus and vagina (uterine prolapse), and other urogynecology problems. We will work closely with you to help you determine which of the surgeries for urinary incontinence discussed above is best suited to your specific needs.
To schedule an appointment with one of our providers, contact (315) 464-5162, or you may use our convenient request form.
