Surgical Management of Urinary Incontinence

1. Sayantika Dhar
Urinary Incontinence
SURGICAL MANAGEMENT

2. Sayantika Dhar
Before the surgery:
•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.

3. Sayantika Dhar
Aim of surgical
management:
•recreating urethral support allowing for the
normal functioning of the urethra during
increased abdominal pressures.

4. Sayantika Dhar
Approaches for Stress
Incontinence
 Abdominal approaches
•Retropubic colpo-suspension
–Burch
–Marshall-Marchetti-Krantz (MMK)
 Contemporary
•Pubo-vaginal sling
•Tension free vaginal tape (TVT)
•Trans-obturator tape (TOT)

5. Sayantika Dhar
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.

6. Sayantika Dhar
Retropubic Colpo-suspension

7. Sayantika Dhar

8. Sayantika Dhar

9. Sayantika Dhar

10. Sayantika Dhar

11. Sayantika Dhar

12. Sayantika Dhar

13. Sayantika Dhar
Pubo-vaginal Slings
•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.

14. Sayantika Dhar

15. Sayantika Dhar

16. Sayantika Dhar
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.

17. Sayantika Dhar

18. Sayantika Dhar

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

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

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

22. Sayantika Dhar
Approach for Urge incontinence:
Augmentation Cystoplasty
Aim: increase bladder size

23. Sayantika Dhar
•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.
Augmentation cystoplasty

24. Sayantika Dhar
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.

25. Sayantika Dhar

26. Sayantika Dhar
Urethral Bulking
Indications:
•Stress or Urge incontinence
•Poor or no response to conservative
management

27. Sayantika Dhar
Aim of bulking
•Build up the thickness of the wall of the
urethra so it seals tightly when you hold back
urine.

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

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

30. Sayantika Dhar
THANK YOU