Minimally Invasive Surgery for Urinary Incontinence
What does Minimally Invasive Surgery Involve?
Surgical techniques for urinary incontinence are fast, safe and only slightly invasive.
Procedures range from a coaptite urethral bulking injection to inserting devices to complement or substitute the working of the urinary sphincter.
These techniques can be performed by endoscopic or open surgery. Anaesthetic is used, either local, spinal or general.
The results are very satisfactory and urine leakage generally stops immediately.
How are Minimally Invasive Surgical Procedures Performed?
The most commonly used and effective treatments for urinary incontinence, both male and female, imply a small procedure. These are more effective and definitive than non-invasive techniques. For each specific patient, the pros (greater effectiveness) and cons (need for a minimally invasive technique) of each type of treatment have to be considered. These procedures use anaesthetic, but patients are usually discharged from hospital on the same or next day.
Surgical procedures and the way they are performed depend on the technique chosen. Some are performed endoscopically, such as bulking injections, while others involve making a small incision in the skin.
The most common treatments are the following:
- Bulking injections;
- Insertion of inflatable or non-inflatable suburethral slings (such as ATOMS);
- Artificial urinary sphincter.
Some surgeries, such as the insertion of an artificial sphincter, may be recommended for some patients, e.g., when changes to cognitive or motor capacity exist
This procedure is performed endoscopically under sedation or spinal or general anaesthetic. It consists of injecting a product to reduce the calibre of the urethra. Different products may be used. These agents are injected around the urethra or into the urethral wall to coapt/close the urethra as a complement to the action of the sphincter.
The procedure is recommended for mild cases of incontinence, i.e., those in which leakage is low. In these cases, the success rate is reasonable.
Insertion of Microballoons
As an alternative to bulking, balloons have been developed that can be implanted endoscopically. The balloon is made of silicone elastomer which is filled with cross-linked hydrogel.
The microballoons are inserted so that they press against the urethra. This surgery must also be performed in cases of mild incontinence.
Initially conceived for female incontinence, these procedures are currently performed on both male and female patients.
In both sexes, a sling is fitted under the urethra. Unlike in the past, in most procedures performed today the sling traverses a structure called an obturator hole. This is why they are called “transobturator” techniques. The aim is to restore the pelvic floor and/or compress the urethra, helping to eliminate urine leakage.
The type of sling used is different for men and women, not just because of the different local anatomical configuration but also due to the different etiopathogenics of incontinence (i.e., its causes and underlying changes).
In men, this type of incontinence is generally due to sphincter-related problems. In women, it may also be due to a sphincter issue or a change in the normal position of the urethra and its relationship to the pelvic floor.
In the case of women, this sling generally comprises a long, thin, rectangular tape regardless of its specific characteristics – such as the type of material, insertion needles and technique used (out-in or in-out).
The devices for men have different configurations and some important differences between them. For example, there are adjustable and non-adjustable slings, the first of which can be “inflatable” (more precisely, full of a special liquid), which allows for adjustment after the operation. An example of this is the Adjustable Transobturator Male System (ATOMS).
These techniques are suitable for moderate incontinence (in men) or moderate/severe incontinence (in women), i.e., with a higher degree of incontinence and a greater volume of leakage.
The role of the tape is to reposition and/or compress the urethra and bulb, restoring the normal working of the sphincter complex. The tapes generally comprise a synthetic material and can be inflatable or non-inflatable. The latter, like those using the aforementioned ATOMS, has the benefit of being adjustable after the procedure. It adapts the degree of urethral compression so that the patient can urinate normally when they want to but do not lose urine when they do not want to.
This is a minimally invasive technique generally performed under general or spinal anaesthetic with a high success rate provided it is used for moderate incontinence.
Insertion of an Artificial Urinary Sphincter
This is the preferred treatment for moderate to severe urinary incontinence caused by sphincter failure. This type of incontinence generally occurs in men who undergo surgery (of the prostate, bladder, urethra or rectum, for example) where a lesion of the sphincter occurs or in women also with severe lesions of the sphincter. Insertion of an artificial sphincter must be done at least six months to a year after surgery and if the conservative measures adopted are ineffective.
In this procedure, a circumferential device with an inflatable cuff is inserted. This cuff is placed around the urethra and compresses it.
The patient themself activates the device every time they want to urinate – ensuring continence whenever they are not urinating.
Urination occurs when a device placed in the scrotum (and which is invisible from the outside) is activated. This moves the liquid inside the cuff away from this location, automatically opening the calibre of the urethra while the patient urinates. Little by little, the liquid returns to the cuff, reclosing the urethra and ensuring continence.
It is intended for more severe cases of incontinence with a high volume of leakage or even constant/continual leakage in which the patient sometimes cannot even fill the bladder and has regular, very frequent or even continual losses.
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What is the Post-Treatment for Minimally Invasive Surgeries?
Hospitalisation is very short, with patients generally being discharged on the same or next day. Patients are discharged after their first post-surgery urination.
Generally, hospitalisation is less than 24 hours, which is very beneficial for patients’ comfort.
After these types of surgeries, it is advised that no exertion is made for varying periods depending on the surgery (15–45 days) and that the patient eat food rich in fibre to prevent constipation, which could affect the area operated on.
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about Minimally Invasive Surgeries for Urinary Incontinence
What minimally invasive surgeries are there?
Are there any complications associated?
What are suburethral slings and what do they do?
How is an artificial urinary sphincter inserted?
- DIAS, José Santos. Urologia Fundamental: na prática clínica. Lisboa: Lidel - Edições Técnicas, Lda, 2010.
- Urine Incontinence - https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814
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