Surgery

If your 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.

Surgery may be appropriate for men who:

• Have ongoing (chronic) incontinence.
• Have severe symptoms and total incontinence.
• Are extremely bothered by their symptoms.
• Have problems with urinary retention.
• Have moderate to severe blood in the urine (hematuria) that is recurrent (keeps coming back).
• Have recurrent urinary tract infections.

Overflow incontinence caused by enlargement of the prostate (benign prostatic hyperplasia, or BPH) is the form of incontinence most often treated with surgery. For more information, see the topic Benign Prostatic Hyperplasia (BPH).

Stress incontinence caused by removal of the prostate gland because of prostate cancer or an enlarged prostate may also be treated with surgery, if the incontinence isn't cured after a period of watchful waiting.

Surgery choices

If overflow incontinence is caused by benign prostatic hyperplasia (BPH), prostate surgery may relieve the incontinence. For more information about surgery options and treatment for BPH, see the topic Benign Prostatic Hyperplasia (BPH).

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.

Factors that increase the chances that surgical treatment will fail to correct incontinence include obesity, long-term (chronic) cough, radiation therapy, age, poor nutrition, and strenuous physical activity.