Other Incontinence Procedures
Bladder Neck Surgery
Bladder Neck Suspension (BNS)
Marshall-Marchetti Operation (MMK)
Suprapubic Sling Operation
The BNS and MMK are traditionally performed through a transverse incision, just above the pubic bone. Just like a caesarean scar. The surgeon opens the plane of tissue which lies between the back of the pubic bone (in front) and bladder (behind).
Sutures are then placed near the bladder neck, passing into the vaginal tissue of the front wall of the vagina. These are then tied either to the back of the pubic bone or to a strong ligament nearby. This elevates the bladder neck.
This operation can also be performed via the laparoscope - another minimally invasive technique.
Regardless, they all rely on the formation of scar tissue to 'hold' everything in place.
I do not perform the traditional sling procedures which involve passing a sling around the bladder neck. These are made from strips of the patients own rectus sheath or another fibrous structure called the fascia lata (in the leg). I cannot comment on its reliability or complications in any depth but it is more 'invasive' than either the BNS or MMK procedure.
Urethral Support Surgery
I prefer the TVT Exact device.
Para-Urethral Injections A small percentage of patients are unsuitable or unable to have surgery. Bulking agents can be injected around the bladder neck and beside the urethra to help reduce leakage.
Prolapse Surgery This is not in itself continence surgery and may make continence better or worse. The outcome is dependent on a host of factors. Prolapse surgery may be required to restore anatomy to a point where a continence operation will be more effective / successful.
Anterior & / or Posterior Vaginal Repair
Enterocele Repair, Vault Support Operations
Vaginal Hysterectomy
Please go to this link and review the possible pathways for treatment.
Credit: https://urogynaecology.com.au/ugsa-surgical-treatment-of-sui-pathway-2016/