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Stress urinary incontinence (SUI) occurs when an increase in abdominal pressure through coughing, sneezing or physical activity is transmitted to the bladder and causes an involuntary leakage of urine due to a weakness in the muscular support around the bladder neck or urethra. Sometimes SUI does not get better with self-management or pelvic floor exercises prescribed by your doctor. In this case, your doctor may recommend surgery.

This section offers general information and situations can vary in different countries.

Surgical treatment

Description

Recommended for

Standard
Midurethral sling A strap that is placed under the urethra* to provide support, most commonly a synthetic (polypropylene) mesh Most patients
Burch colposuspension An operation to support the bladder neck, which connects the bladder to the urethra, to resist pressure Patients who cannot have a synthetic or midurethral sling
Autologous fascial sling A strap made from the patient’s own body tissue that is placed under the urethra to provide support Patients who cannot use a synthetic or midurethral sling
Special situations
Bulking agents Substance that is injected into the wall of the urethra to improve closure. In general, a temporary effect Patients who are not eligible for surgery, only expect a short-term benefit, or want to postpone surgery
Artificial urinary sphincter An inflatable cuff placed around the urethra connected to a hand-controlled pump that allows you to pass urine Patients with complex problems for whom other treatments have not worked

*The urethra is a tube that allows passage of urine from the bladder.

Preparation for and recommendations after the procedure

How do I prepare for the procedure?

Before surgery, the doctor will ask for a urine sample. This will be tested to make sure you do not have a urinary tract infection. If you have an infection, your doctor will prescribe antibiotics for you to take before, during, and after the operation.

Your doctor will advise you in detail about how to prepare for the procedure. If you need general anaesthesia, you must not eat, drink, or smoke for 6 hours before the surgery. If you take any prescribed medication, discuss it with your doctor. You may need to stop taking medication several days before surgery. Your doctor will advise you on when you can start taking it again.

How long will it take me to get back to my daily activities?

This depends on the procedure performed. The doctor may remove the catheter right after the procedure or wait a few days after surgery.

  • You can usually leave the hospital on the day or 1 day after insertion of a midurethral sling. Two or three days may be needed after Burch colposuspension or implantation of an autologous fascial sling or an artificial urinary sphincter.
  • Injection of bulking agents is often performed at a clinic or doctor’s office (outpatient setting).
  • You may have to stay in the hospital longer if you are unable to urinate or your bladder is not emptying completely.
  • The recommended length of hospital stay varies between countries. Complete recovery from surgery may take up to 6 weeks. During this time, you may have pain in the pelvic area or when you urinate. Your doctor can prescribe medication for these symptoms.

Recommendations for 4–6 weeks after surgery:

  • Drink 1–2 litres every day, especially water
  • Do not lift anything heavier than 5 kilograms
  • Do not do any heavy exercise
  • Take showers instead of baths
  • Avoid thermal baths or going to the sauna
  • Adapt your diet to prevent constipation
  • Avoid vaginal penetration

Call your doctor or go back to the hospital right away if you:

  • Develop a fever
  • Are unable to urinate
  • Have heavy blood loss or pain
  • Notice the wound starts to bleed or leak clear fluid
  • Notice the wound hurts