Incontinence Surgery: Indications, Options & When It's Considered

Surgery is reserved for incontinence refractory to conservative measures (pelvic floor therapy, behavioral modification, pessaries, medications).

Stress Urinary Incontinence (SUI) – Surgical Options

• Midurethral sling (retropubic/transobturator): Gold standard; synthetic mesh supports urethra. Cure rates 80–90%.
• Autologous fascial sling: Patient's own tissue; lower erosion risk; longer recovery.
• Burch colposuspension: Open/laparoscopic; sutures elevate bladder neck. Durable but more invasive.
• Urethral bulking agents: Office-based; less durable; for poor surgical candidates.

Urgency Incontinence / OAB – Surgical/Advanced Options

• Sacral neuromodulation (InterStim): Implanted neurostimulator; modulates bladder reflexes.
• Percutaneous tibial nerve stimulation (PTNS): Weekly office sessions ×12, then maintenance.
• Intradetrusor onabotulinumtoxinA (Botox): Cystoscopic injection every 6–12 months.
• Augmentation cystoplasty / urinary diversion: Last resort for end-stage bladder.

Pre-Surgical Requirements

• Urodynamic confirmation of diagnosis.
• Failed ≥3 months supervised pelvic floor PT.
• Optimized medical management.
• Counseling on risks: mesh complications (exposure, pain), retention, de novo urgency, infection.

Shared decision-making with a urogynecologist/urologist ensures appropriate procedure selection.