Surgical Treatment for Urge Incontinence
Surgery is recommended to treat urge incontinence only after other treatment options have proven unsuccessful.
Bladder Augmentation to Treat Urge Incontinence
This procedure increases the capacity of a small, hyperactive, or nonresilient bladder by adding bowel (intestine) segments or by reducing the muscle-squeezing ability of the bladder (autoaugmentation). Patients who are unable to perform self-catheterization (i.e., placement of a urinary catheter by the patient) or who have a kidney disorder, bowel disease, or urethral disease are not candidates for bladder augmentation.
Segments from the last part of the small intestine (ileum), the first part of the large intestine (cecum), or the junction between the small and large intestines (ileocecum) can be used to enlarge the bladder. The bladder is opened at the dome and cut on right angles on each side. The bowel segment is joined to the bladder with sutures.
In autoaugmentation, the smooth muscle that contracts the bladder to expel urine (detrusor) is cut out of the dome of the bladder, leaving the mucous membrane intact. This results in reduced muscle contraction and improved function in an overactive bladder.
Sacral Nerve Stimulation
InterStim therapy is a reversible treatment for people with urge incontinence caused by overactive bladder who do not respond to behavioral treatments or medication. InterStim is an implanted neurostimulation system that sends mild electrical pulses to the sacral nerve, the nerve near the tailbone that influences bladder control muscles. Stimulation of this nerve may relieve the symptoms related to urge incontinence.
Prior to implantation, the effectiveness of the therapy is tested on a outpatient basis with an external InterStim device. For a period of 3 to 5 days, the patient records voiding patterns that occur with stimulation. The record is compared to recorded voiding patterns without stimulation. The comparison demonstrates whether the device effectively reduces symptoms. If the test is successful, the patient may choose to have the device implanted.
The procedure requires general anesthesia. A lead (a special wire with electrical contacts) is placed near the sacral nerve and is passed under the skin to a neurostimulator, which is about the size of a stopwatch. The neurostimulator is placed under the skin in the upper buttock.
Adjustments can be made at the doctor's office with a programming device that sends a radio signal through the skin to the neurostimulator. Another programming device is given to the patient to further adjust the level of stimulation, if necessary. The system can be turned off at any time.
Injection of botulinum toxin (Botox) into the bladder muscle (called Botox intravesical injection) is an experimental treatment for urge incontinence that does not respond to other therapies. This treatment has been shown to help reduce the instability that leads to urgency.