Anti-urinary incontinence procedures (TVT, TOT, Burch, urethral bulking agens, Interstim)
The anti-urinary incontinence procedures obviously are designed to correct various types and degrees of involuntary urinary loss. As we specified in the urinary incontinence chapter, there are mainly two major types of incontinence: stress and urge. Further subclassifications are available but beyond the purpose of this bulletin. The most effective correction available today regards the stress incontinence. With respect to the urge, the treatment is mostly medical although a recent implant (Interstim) has been described. Due to conflicting experimental reports we don’t encourage this specific implant at this point although we are able to offer it as a surgical service on per-request basis with appropriate informed consent of the patient.
On the other hand we encourage the understanding of anti-stress urinary incontinence procedures. The bulking agents address to intrinsic sphincter deficiencies and are collagen-based compounds that can be injected locally to increase the coaptation pressure. However the indications are very limited and always require urodynamic confirmation. The bladder suspension procedures may be done with mesh (sling) or without mesh (Burch). The route is essentially different: transvaginal for slings and transbdominal for Burch (laparoscopic or open).
To address some of the mesh related procedures controversies, we would like to emphasize on the extensive usage of this product in surgeries for decades (see hernia repairs). There are indeed situations when the foreign material may cause problems, but other times it is indispensable. The unwise indiscriminatory elimination of all the mesh-techniques, even if in this instance the effective size of the material is no more than 5 mm width and 2 inches long, may have devastating consequences on the remaining available techniques. Keep in mind that even though the Burch bladder neck suspension (if executed correctly only) is initially as effective as the sling, it uses the patient’s own tissue for support. By the same mechanism of age-dependent conjunctive laxity that caused the incontinence in the first place, the same symptoms may recur after a number of years. On the other hand the mesh has the same length and the supportive bridge remains equal for the entire patient’s life.
Most of the time the concomitant problems dictate a certain route of surgery and adding the anti-incontinence procedure depends on the overall approach. As dedicated to excellence in patient education and care we offer you detailed information and statistics to help you conclude upon the technique you choose.