Stress incontinence surgery options

Retropubic midurethral sling

Use of synthetic mesh sling or graft (fascia lata) to provide midurethra support. Figure (a) illustrates sling placement behind pubic bone through a small vagina incision just underneath the urethral opening Figure (b) Overview of sling in relation to pelvis.

Burch colposuspension

A mesh free stress incontinence surgery using sutures into the ligament on the pubic bone (Cooper’s ligament) to support the midurethra like a hammock. Illustration demonstrates the Burch procedure (retropubic and pelvic side view).

Urethral bulking injections

This procedure bulks up the urethral lumen (cushion effect/filler) to improve the closure pressure of urethra. Figure (a) Lateral pelvic view, weak closure of bladder neck resulting in leakage; (b) Bulking agent injected; (c) After injection with good bladder neck seal preventing stress incontinence.

Pubovaginal sling

Native tissue mesh free surgery option for stress urinary incontinence. This procedure is more invasive than other options and generally reserved for recurrent stress incontinence or if a patient has had mesh complications. Rectus fascia graft harvested (Figure a) and introduced into the retropubic space similar to the retropubic sling technique (Figure b). Graft end is sutured onto rectus sheath and tensioned accordingly to provide midurethra support (Figure C – pelvic side view)