Surgery For Overactive Bladder

Surgical Options For Overactive Bladder

Overactive Bladder at its best (is there really such a thing?) can be annoying. The constant running to the bathroom can be frustrating to say the least. But at its worst, OAB can be debilitating. Those with severe OAB make multiple trips to the bathroom a day and even night, and many times may have embarrassing accidents too.  It can cause anxiety in social situations, limit interaction with friends and family, and can even negatively affect a person’s work. If you think you’ve tried everything and it hasn’t worked for you, surgery may be an option.

Surgery is typically a last resort for most people and should be considered only after more conservative options, such as behavioral modifications, medication or even advanced therapies like Sacral Neuromodulation have failed.  The surgeries listed below are often done on women who no longer wish to have children, as childbirth can often remove many of the benefits of surgery.   

What types of surgeries are available?

Augmentation Cystoplasty

This procedure increases the size of the bladder, enabling the bladder to store more urine. A small amount of tissue is typically taken from the intestine and added to the wall of the bladder to make it bigger. In some cases, a catheter may be needed after this surgery has been performed.

Urinary Diversion

This procedure takes the tubes that lead from the kidneys to the bladder, and reroutes them through the abdominal wall to the outside of the body. Urine is then collected in an ostomy bag – a specially designed bag to be worn on the abdomen. While this option does require maintenance (emptying the bag, keeping the area clean and safe from infection) it does allow an active life post surgery. 

Sling Procedure

Vaginal sling procedures are surgeries that help control stress urinary incontinence, which happens when you leak urine upon coughing, laughing, sneezing, lifting or exercising. The basic concept of a sling is to place a strong piece of material beneath the urethra as a supporting “hammock”. During the procedure, physicians use a sling placed around the urethra to lift it, or the bladder, back into a normal position.

There are many different types of sling procedures, as well as a number of different sling materials available, so talk to your doctor about your options, as well as the pros and cons for each one.

Is surgery for me?

The decision to have surgery can be difficult, as there are pros and cons with each procedure. But, if your OAB symptoms are severe, and you have tried all other options, surgery may be right for you. Be sure to talk with your doctor about all of your options, including what the procedure is like, the materials used, the pros and cons of different surgical options, and the recovery times for each.  It’s also important to talk with your doctor about what you can expect after surgery, as not everyone is completely cured from incontinence after these procedures.  A frank discussion with your doctor, and your own research on surgical options can help you decide if this is a path you would like to consider.

 Learn more about surgery options for OAB in our 6th and final video of our series on managing Overactive Bladder. 

Patient Perspective: Nick's Story

Nick's Story - Incontinence After Prostate Removal

In August of 2015, I underwent surgery to have my prostate removed.  I had been diagnosed with prostate cancer the year before and my doctor had been closely observing me since then. 

When it seemed that my cancer was growing more quickly than he liked, he suggested surgery.  “Afterall”, he said, “you’re only 63.  You can still have a long life without worrying about this.”

So, after a lot of research, I went for it.  I knew there would be complications afterward, but incontinence was not something that I had anticipated being that big of a deal.  I thought I’d probably have to wear diapers for a couple of weeks and that would be the end of it. 

Boy was I wrong. 

Nine months later and I was still having a difficult time making it to the restroom.  It was so embarrassing as a man to face this problem. I couldn’t do the things I wanted to because I was scared of having an accident or a leak, and I felt ashamed of the bulky diapers that I was forced to constantly wear. 

I finally made an appointment with a surgeon in May to discuss a sling procedure and will be having the procedure done next month.  I’m hopeful that this will be a solution for me so that I can get on with my life and get back to doing the things that are important to me. 

Nick W., Houston, TX

Ask The Expert: Surgery For BPH?

Ask The Expert: Surgery For BPH?

Each month, we ask our expert panel to answer one of our reader's questions. To learn more about the NAFC Expert Panel, and how to submit your own question, see below.

Question: What types of surgery options are available for BPH?

Answer: BPH, or Benign Prostatic Hyperplasia, is when a man’s prostate is enlarged.  BPH is a common occurrence in aging men, but may not always require surgery.  Surgery may be considered if you have certain issues (you can’t urinate, have seen blood in your urine, have a partial blockage in your urethra, or have kidney damage), or if your symptoms are so bothersome that surgery makes sense to you.

The typical surgical option that is usually used is transurethral surgery of the prostate.  This is where surgical instruments are passed through the opening in the penis to the prostate. Transurethral resection of the prostate (TURP) is the most common type of transurethral surgery used for BPH. This is when a portion of the prostate is removed.  Other methods of removing some of the prostate include laser therapies, transurethral microwave therapy (TUMT), or transurethral needle ablation (TUNA).  Transurethral incision of the prostate (TUIP) is also sometimes used, which places incisions on the prostate which help to relax the opening to the bladder and allow urine to flow from the bladder more freely.

If you are considering surgery for BPH, talk with your doctor about these options and decide together which one may be the best for you.

The NAFC Expert Panel is made up of some of the top medical professionals in the fields of urology, urogynecology, physical therapy, and surgery. Each month, the experts weigh in on important topics and answers to your questions.  To have one of your questions featured in our Ask an Expert series, send it to us here.

Can OAB Be Treated With Surgery?

Can OAB Be Treated With Surgery?

When Dalia was 28, she had her first child. She’d had a normal pregnancy, and like many of her friends, had some light leakage after birth, but nothing serious.  Baby #2 followed two years later, and baby #3 one year after that.  It was then that she really began to see a difference in her bladder control. “It was like the flood gates had suddenly opened,” Dalia said.  “Any little thing could trigger an urgent bathroom visit.” 

Concerned, Dalia went to her doctor to ask what could be done.  After trying several options that had no effect, or uncomfortable side effects, her doctor finally suggested surgery.  “I was really nervous at first – surgery sounds like such a scary word,” she said. 

After reviewing all the options, Dalia’s doctor recommended Interstim to treat her incontinence. Interstim therapy is a form of sacral nerve stimulation, where a device is implanted, usually in the buttocks and helps to block the messages sent by an overactive bladder to the brain, telling the brain that you need to use the restroom. 

After the procedure, she saw immediate improvement. “I can’t believe that I waited as long as I did to have this done,” she said. “It’s been a life changer.”

Many women like Dalia suffer from overactive bladder – the urgent and frequent need to use the restroom.  It is estimated that over 33 million people in America struggle with the condition.  And while there are many treatment options available, they don’t always work for everyone.  Initial treatment options like physical therapy, diet regulation, and bladder retraining can do wonders for many, and medications can often help those suffering from OAB.  However some still don’t find relief from these options, and some medications can cause unwanted side effects.  Luckily, there are several surgical options that are effective in improving OAB symptoms. 

What are my options?

Sacral Nerve Stimulation. 

This procedure, like the one Dalia had, regulates the nerve impulses in the bladder.  A small pulse generator is implanted under the skin and blocks messages sent by your bladder to your brain, regulating the nerve impulses in your bladder and reducing the need to urinate unnecessarily. The device can remain in place for as long as you need it, and the process is an outpatient procedure that uses local anesthesia and mild sedation.

Augmentation Cystoplasty.

Augmentation Cystoplasty, is a procedure that increases the size of the bladder.  Often used in severe cases after other treatments have failed, it enables the bladder to store more urine. Your doctor will take a small piece of tissue from your intestine and add it onto the wall of the bladder to enlarge it.  In some cases, a catheter may be needed to empty the bladder after this procedure has been performed.

Urinary Diversion.

Urinary Diversion reroutes the tubes that lead from the kidneys to the bladder to outside of the body through the abdominal wall.  Urine is then collected in an ostomy bag – a specially designed bag to be worn on the abdomen.  This option does require some maintenance, however it allows you to live an active life post surgery. 

Talk To Your Doctor.

Surgery is a common approach for many who have failed on other treatment plans, and your doctor will be able to help you find the best option.  It is important to talk with your doctor to determine not only what type of surgery might work best for you but also when might be the best time to have it.  For example, women who are still interested in having children may wish to wait, since childbirth may compromise any surgery that has already been performed.  Additionally, be sure to ask your doctor about what you can expect post surgery – some surgeries are designed to treat specific symptoms of incontinence, so you may still need medication or physical therapy to treat the other symptoms you experience.

If you are considering surgery, a urological surgeon can help talk through your options.  Visit the NAFC Specialist Locator to find one near you.