Richmond OB-GYN | Bon Secours

Laparoscopic Treatment of Urinary Stress Incontinence

Urinary incontinence — the involuntary loss of urine — dramatically affects the lives of 17 million American men and women of all ages. Because of the stigma associated with the condition, many are too embarrassed to talk about their problem. As a result, less than half seek treatment even though approximately 80% can be cured. When left untreated, incontinence often leads to social isolation, depression and low self-esteem.
More than half the people with incontinence suffer from urinary stress incontinence. In the past, these people sought relief by dramatically altering their lifestyle or by undergoing an effective, but debilitating, surgical procedure. Because traditional surgery involves a large incision, a 3- to 6-day hospital stay and up to 6 weeks of recovery at home, it was typically limited to those patients who do not respond well to other forms of treatment.
Now, a laparoscopic technique makes it possible to perform the same operation, bladder neck suspension, without the long hospital stay or difficult recovery. Most patients can go home in as little as a day with only 3 tiny marks. In most cases, they can resume normal activities within a week.

Questions & Answers

What is urinary incontinence?
Loss of bladder control is not a disease, but rather a sign that a problem exists. There are 4 basic forms of urinary incontinence: stress, urge, overflow and reflex. They are caused by a number of possible conditions or disorders that affect the urinary system.

What is urinary stress incontinence?
Urinary stress incontinence occurs when the urethral sphincter or pelvic muscle cannot adequately support the bladder. This allows the bladder to slip down into the pelvic cavity and place pressure on the urethra, the duct that carries urine from the bladder to outside the body. As a result, body movements, such as exercising, coughing or sneezing, can place additional pressure on the bladder causing it to leak. Although it can affect anyone, it is a common condition among women who have gone through childbirth or menopause.

How is urinary stress incontinence treated?
Once a diagnosis has been made, stress incontinence is usually treated with lifestyle adjustments, exercises and medication. While these forms of treatment can be effective in mild cases of stress incontinence, patients with more severe cases sometimes require surgery. In these cases, a surgical procedure, known as bladder neck suspension, alleviates the pressure placed on the urethra by elevating the neck of the bladder. Although effective, the traditional “open” procedure requires a large incision and a long, painful recovery. Using laparoscopic techniques, surgeons can now perform the same procedure through 3 tiny openings.

How is laparoscopic bladder neck suspension performed?
In the laparoscopic procedure, the surgeon uses a trocar (a narrow, tube-like instrument) to gain access to the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through the trocar, giving the surgeon a magnified view of the patient’s internal organs on a television monitor. Two additional trocars are used for special instrumentation.
After lifting the tissue adjacent to the bladder into position, the surgeon attaches it to the pelvic bone using the ENDO STITCH* suturing device, a small strip of plastic mesh and tiny permanent anchors. Following the procedure, the small incisions are closed with a stitch or two or with surgical tape. Within a few months, the incisions are barely visible.

Is bladder neck suspension effective?
Since it’s introduction in 1958, “open” bladder neck suspension has become the “gold standard” in surgical treatment for urinary stress incontinence. Studies have shown that approximately 75-90% of all patients remain continent or see a marked improvement. Many surgeons expect similar results with the laparoscopic approach because the actual bladder suspension is performed in the same way.
In the past absorbable materials were used that dissolved, depending on scar tissue to hold in the long term. This new technique uses all non-absorbable materials that should hold forever.

What are the advantages of laparoscopic bladder suspension?
By operating through 3 tiny openings instead of the traditional 5-inch incision, most laparoscopic patients experience less pain, less scarring, a shorter hospital stay and a quicker recovery than patients undergoing the open procedure. In addition, most patients do not require long-term catheterization after surgery. With the traditional procedure, patients are often catherized for an average of 8 days.
About 50% of patients will go home with a small catheter that is inserted in the pubic area. The other half will have this removed before they go home from the hospital.
How long will I be in the hospital?
Most patients leave the hospital the day after laparoscopic bladder neck suspension. In comparison, most patients who undergo the traditional procedure spend 2 to 3 days in the hospital.

When can I go back to work?
Most patients can return to work and other normal activities in as little as a week following the laparoscopic procedure. This compares with 4 to 6 weeks for patients who have open bladder neck surgery. Patients should not lift more than 15 pounds for six weeks after surgery to allow the area to heal in completely. So if work involves heavy lifting, return to work may be later than one week.

Should I be concerned that laparoscopic bladder neck suspension is new?
Minimally invasive surgical techniques have been used in gynecologic surgery for nearly 3 decades, and today, more than 90% of all gallbladder surgery is performed using these techniques. More recently, surgeons have applied minimally invasive techniques to a broad range of procedures including hernia repair, appendectomy, hysterectomy, heartburn surgery and lung and bowel surgery.
Dr. Wiles has refined this surgery over several years and has done more than 75 cases with excellent results.

Am I a candidate for laparoscopic bladder neck suspension?
Although there are many benefits associated with laparoscopy, it may not be appropriate for some patients, including those who have had previous abdominal surgery or who have some pre-existing medical conditions. A thorough gynecologic evaluation by Dr. Wiles can determine if laparoscopic bladder suspension is an appropriate procedure for you.
* Trademark of United States Surgical Corporation