Stress incontinence surgery

Bladder neck suspension by colposuspension is used for stress incontinence caused by slippage of the bladder. There are different types of this kind of surgery.

The bladder is suspended with stitches at the pubic bone area to keep it in place. It can be done through a large cut made in the abdomen or through keyhole surgery.

Needle suspension aims to achieve the same result of colposuspension but uses a different technique. The bladder is suspended by a nylon thread that goes to the skin's surface.

Anterior vaginal repair is another type of correcting operation. It's done when the bladder and urethra have slipped into the vagina (prolapse) and need to be put back in place.

The surgeon doesn't pull the tape, which is why it's called tension-free

Vaginal sling is an operation to place strips of material under the bladder, the bladder neck and the urethra in a hammock-style arrangement. This helps support the bladder in its proper position. The strips can be made of different materials, both manmade and natural.

Tension-free vaginal tape (TVT) is a form of sling. The procedure is shorter and less invasive. The tape is inserted below the urethra, providing suspension and stabilizing of the bladder. The tape is inserted through the vagina and is wrapped around the urethra. Its suspension is established by securing it to your abdomen through small cuts.

The surgeon doesn't pull the tape, which is why it's called tension-free. The scar tissue formed over the tape's ends in your abdomen is enough to keep it in place.

Other surgical techniques

Urethral balloon implants and artificial sphincter are new procedures. Urethral balloons are implanted on either side of the urethra. Fluid is used to fill the balloons which then puts pressure on either side of the urethra keeping it closed and providing continence. A tubing system with a small port is placed under the skin allowing access for volume adjustments to enable individual alteration. Urination happens in a natural manner and no manipulation is needed.

An artificial sphincter works similarly to the balloons, providing external pressure by implanting a ring around the urethra that is filled with fluid. The ring is used to open and close the urethra by filling and emptying the fluid. To do that, a device is placed under the skin that controls the ring. During urination, the device is activated manually which then releases the pressure around the urethra by emptying the fluid from the ring, and then the urethra opens.

Urethral bulking agents or implants make use of injections of, for instance, your own fat cells or bovine collagen, to create more bulk around the urethral area. That helps the body keep the urethra and bladder opening closed.

Natural bulking agents are reabsorbed into the body and wear off, decreasing durability of improvements and requiring repeat treatments. Synthetic bulking agents aren't reabsorbed into the body but long-term durability is generally low.

Using bulking agents (collagen) is relatively new.

Urethral balloons are implanted on either side of the urethra. Fluid is used to fill the balloons which then put pressure on either side of the urethra keeping it closed

Botox injection is under investigation as a therapy for bladder problems but is not approved by health authorities or assessed by long-term studies.

Botox (the same material that's used for  cosmetic medicine) is injected into the bladder wall. Its goal is to block the chemicals that tell the bladder to contract and therefore relieve symptoms of overactive bladder syndrome.

Surgery for prostate gland enlargement

Prostate surgery for prostate enlargement (benign prostatic hyperplasia and benign prostatic hypertrophy) is when the enlarged prostate is surgically reduced in size or removed.

This reduction or removal takes the pressure off the urethra allowing a better flow of urine.

There are different surgical procedures to do this: surgically removing the obstructing part or all of the prostate is called transurethral resection of prostate.

Radiowaves are used to burn parts of the prostate, reducing its size

A minimally invasive procedure is transurethral needle ablation therapy. Two needles are inserted into the prostate, heated by radiowaves and producing targeted thermal ablation (removal of tissue) inside the prostate.

Another form of this therapy uses microwaves instead of radiowaves. It's called transurethral microwave therapy.

Catheter

A catheter is a tube used to manually empty the bladder through the urethra or abdomen.

Intermittent catheterisation is emptying of the bladder without a permanent catheter. Indwelling catheterisation is when the tube stays in the bladder for a longer period. A Foley catheter is a long-term device.