The surgical options for stress incontinence include urethral bulking, colposuspension and sling procedures.

This procedure is used to treat stress urinary incontinence. A synthetic permanent substance (commonly Bulkamid®) is injected into the muscular wall of the urethra (water pipe). The injection is carried out under direct vision using a thin camera.

The injected material bulks up the wall of the urethra, helping it to close more effectively and reducing urine leakage.

How is the para-urethral procedure done?

The procedure can be performed under local, spinal, or general anaesthetic. A thin camera is passed into the urethra to guide the injection. Small amounts of the bulking agent are injected into the wall of the urethra. No cuts or incisions are required. It is usually carried out as a day procedure, meaning you can go home the same day.

What results can I expect?

The procedure is less invasive than other operations such as the autologous fascial sling or Burch colposuspension. While the success rate is lower and the effect may wear off with time, many women notice an improvement in leakage. If symptoms return, the injection can be repeated (“top-up”) or another treatment can be considered.

Common Questions

How effective is this specific treatment?
Many women notice an improvement in leakage, although the long-term cure rate is lower than with more invasive procedures.

Will I need another injection?
The effect may wear off with time. If symptoms return, the injection can be repeated, or you may consider a different treatment option.

What are the risks?
Risks are low compared with other operations. Some women may notice temporary burning when passing urine, a small amount of bleeding, or a urinary tract infection, but serious complications are rare.

What is a Burch colposuspension?

The Burch colposuspension is one of the original operations for stress urinary incontinence. First described in the 1960s, it has seen a return as an alternative to mesh midurethral sling operations (e.g. TVT), which are currently restricted in the UK.

The operation is performed under a general anaesthetic and can be carried out either as a laparoscopic (keyhole) procedure or through an open cut in the lower tummy.

How is the operation done?

In the laparoscopic (keyhole) approach, small cuts are made in the abdomen. Using a camera, the surgeon reaches the area behind the pubic bone and above the vagina. Permanent stitches are then placed on each side of the urethra, through the vaginal wall, and anchored to strong supporting tissues near the pubic bone (Cooper’s ligaments). This provides support to the urethra and helps prevent leakage when you cough, laugh, sneeze, or exercise. The open approach is only different in that one incision (above the pubic bone) is used for access.

At the end of the operation, a cystoscopy (camera test inside the bladder) maybe performed to check the bladder and ureters (the tubes from the kidneys). A catheter is then placed into the bladder and usually kept in overnight. Before discharge, the catheter is removed and the team will check that you are passing urine properly.

Common Questions

How effective is the Burch colposuspension?
Most women notice a significant improvement in stress incontinence. Long-term studies show good results that can last for many years, although some women may find symptoms slowly return over time.

How long will it take me to recover?
Most women stay in hospital for one or two nights. Full recovery takes around 4 to 6 weeks. During this time you should avoid heavy lifting and strenuous exercise, but light activity and gentle walking are encouraged as you feel able.

What are the risks?
As with any operation, there are risks such as bleeding, infection, or injury to nearby structures like the bladder or ureters. Some women find it difficult to pass urine immediately afterwards, but this usually improves. Rarely, long-term problems with bladder emptying can occur.

What is an autologous rectus fascial sling?

This operation is used to treat stress urinary incontinence. Unlike mesh sling procedures, it uses your own body tissue to create the sling. The tissue is taken from the rectus sheath, which is a strong layer in the abdominal wall.

The procedure is usually performed under a general anaesthetic. It involves a cut in the lower tummy and a small incision in the vagina. The strip of tissue taken from the abdominal wall is placed under and around the urethra (water pipe) through the vaginal incision. The ends of the sling are then tied back over the rectus sheath.

This provides support to the urethra and helps to prevent urine leakage when you cough, laugh, sneeze, or exercise.

How is the operation done?

A cut is made in the lower abdominal wall to take a strip of tissue from the rectus sheath, a small incision is then made in the vagina to allow the sling to be positioned under the urethra. The sling is then brought up through the vaginal incision and tied over the rectus sheath, creating support for the urethra.

A cystoscopy (camera test into the bladder) is performed to ensure there has been no injury to the bladder or ureters (the tubes connecting the kidneys to the bladder). A catheter is placed into the bladder and usually kept in overnight, before discharge, the catheter will be removed and the team will make sure you can empty your bladder properly.

Common Questions

How effective is the autologous sling?
Most women notice a significant improvement in stress incontinence. Because the sling is made from your own tissue, it avoids the use of synthetic mesh and usually provides durable support.

How long will it take me to recover?
Recovery is a little longer than with mesh sling procedures, as it involves both an abdominal and vaginal incision. Most women stay in hospital for one or two nights, and full recovery usually takes 6 to 8 weeks. You should avoid heavy lifting and strenuous activity during this time, but light activity and walking are encouraged.

What are the risks?
As with any surgery, there are risks including infection, bleeding, and injury to surrounding structures. Some women may experience difficulty passing urine after the operation, which can require a catheter for longer or additional procedures. Scar tissue, urgency symptoms, or long-term voiding problems are less common but possible. There will also be a small abdominal scar where the tissue was taken.

Success rates for stress incontinence surgery range from 70–90%.

The risks of stress incontinence surgery include urinary retention, infection, or persistent leakage.

Most patients return to work within within 2 to 4 weeks after stress incontinence surgery.

A catheter is at times temporarily needed for bladder drainage.