Minimally Invasive Surgery for Urinary Incontinence

This procedure is performed endoscopically under sedation or spinal or general anaesthetic. It consists of injecting a product to reduce the calibre of the urethra. Different products may be used. These agents are injected around the urethra or into the urethral wall to coapt/close the urethra as a complement to the action of the sphincter.

The procedure is recommended for mild cases of incontinence, i.e., those in which leakage is low. In these cases, the success rate is reasonable.

As an alternative to bulking, balloons have been developed that can be implanted endoscopically. The balloon is made of silicone elastomer which is filled with cross-linked hydrogel.

The microballoons are inserted so that they press against the urethra. This surgery must also be performed in cases of mild incontinence.

Initially conceived for female incontinence, these procedures are currently performed on both male and female patients.

In both sexes, a sling is fitted under the urethra. Unlike in the past, in most procedures performed today the sling traverses a structure called an obturator hole. This is why they are called “transobturator” techniques. The aim is to restore the pelvic floor and/or compress the urethra, helping to eliminate urine leakage.

The type of sling used is different for men and women, not just because of the different local anatomical configuration but also due to the different etiopathogenics of incontinence (i.e., its causes and underlying changes).
In men, this type of incontinence is generally due to sphincter-related problems. In women, it may also be due to a sphincter issue or a change in the normal position of the urethra and its relationship to the pelvic floor.

In the case of women, this sling generally comprises a long, thin, rectangular tape regardless of its specific characteristics – such as the type of material, insertion needles and technique used (out-in or in-out).

The devices for men have different configurations and some important differences between them. For example, there are adjustable and non-adjustable slings, the first of which can be “inflatable” (more precisely, full of a special liquid), which allows for adjustment after the operation. An example of this is the Adjustable Transobturator Male System (ATOMS).

These techniques are suitable for moderate incontinence (in men) or moderate/severe incontinence (in women), i.e., with a higher degree of incontinence and a greater volume of leakage.

The role of the tape is to reposition and/or compress the urethra and bulb, restoring the normal working of the sphincter complex. The tapes generally comprise a synthetic material and can be inflatable or non-inflatable. The latter, like those using the aforementioned ATOMS, has the benefit of being adjustable after the procedure. It adapts the degree of urethral compression so that the patient can urinate normally when they want to but do not lose urine when they do not want to.

This is a minimally invasive technique generally performed under general or spinal anaesthetic with a high success rate provided it is used for moderate incontinence.

This is the preferred treatment for moderate to severe urinary incontinence caused by sphincter failure. This type of incontinence generally occurs in men who undergo surgery (of the prostate, bladder, urethra or rectum, for example) where a lesion of the sphincter occurs or in women also with severe lesions of the sphincter. Insertion of an artificial sphincter must be done at least six months to a year after surgery and if the conservative measures adopted are ineffective.

In this procedure, a circumferential device with an inflatable cuff is inserted. This cuff is placed around the urethra and compresses it.

The patient themself activates the device every time they want to urinate – ensuring continence whenever they are not urinating.

Urination occurs when a device placed in the scrotum (and which is invisible from the outside) is activated. This moves the liquid inside the cuff away from this location, automatically opening the calibre of the urethra  while the patient urinates. Little by little, the liquid returns to the cuff, reclosing the urethra and ensuring continence.

It is intended for more severe cases of incontinence with a high volume of leakage or even constant/continual leakage in which the patient sometimes cannot even fill the bladder and has regular, very frequent or even continual losses.