urinary incontinence has not improved after trying
behavioral methods and medicine and if your doctor thinks
surgery will be an effective treatment, you may choose to have surgery rather
than live with your symptoms. In some cases, such as when a bladder outlet
obstruction is affecting kidney function, surgery may be the only way to treat
the problem that is causing the incontinence.
By Tom Chiarella
First you remind the person what you are thanking them for.
Then you tell them why. That's it.
A good thank-you note is a clear and ruddy piece of prose. There are only
two moves involved. First you remind the person what you are thanking them for.
Then you tell them why. That's it. You sign off, sure. And you might throw in
an extra sentence or two for a laugh or a private joke. But it's mostly a
chop-chop exercise: two solid, sincere sentences, each touching...
Surgery for severe stress incontinence that does not improve with
behavioral methods includes:
Artificial sphincter, which is a device
made of silicone rubber that fits around the urethra (the tube that carries
urine from your bladder to the outside of your body) and can be inflated or
deflated to control urination.
Urethral bulking, which involves injecting material around the urethra to control
urination by either closing a hole in the urethra or building up the thickness
of the wall of the urethra.
Bulbourethral sling, which is being
studied as a treatment for urinary incontinence that results from prostate
surgery. In this procedure, a sling is placed beneath the
urethra to support it and is attached to either muscle
tissue or the pubic bone. The sling compresses and elevates the urethra, giving
the urethra greater resistance to pressure from the abdomen.
Sacral nerve stimulation (SNS). In SNS, the doctor puts an electrical stimulator under your skin above your buttocks. This stimulator looks like a pacemaker. It is attached to electrodes that send pulses to a nerve in your lower back (sacrum). The sacral nerve plays a role in bladder storage and emptying.
What to think about
Surgery is usually not considered
for urinary incontinence unless it is the only reasonable way to cure it or
after attempts to treat the problem with conservative measures or other
treatment have failed. The decision to have surgery must always be based on an
accurate diagnosis and realistic expectations for the surgery.
Most surgical failures are due to incorrect diagnoses. Other reasons for
failure include healing problems, additional causes of incontinence that aren't
apparent before the surgery, and a lack of experience or skill on the part of
the surgeon performing the procedure.