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Urinary Incontinence
The Effects, Treatment and Causes of Overactive Bladder
By Donna Smith
One of the most common causes of leakage is stress urinary incontinence from prolapsed pelvic organs due to weakened pelvic muscles because of childbirth or age. Prolapsed organs, including the bladder, urethra, small intestine, rectum, uterus and vagina, can usually be surgically corrected.
For decades, the standard surgical approach involved opening up the abdomen and sewing the bladder neck and urethra to the pelvic bone. Recovery took three to four days. By 1999, open surgery was being replaced by a "sling" procedure, a less-invasive, vaginal surgery in which a sling, made from a mesh material, is attached under the urethra and bladder neck.
The newest form of sling surgery, introduced in 2004, is the mid-urethral trans-obturator-tape (TOT) procedure, which uses a narrow strip of synthetic material to cradle the urethra and allow it to close more tightly. Two tiny skin incisions are made near the inner thigh and the hammock is inserted through the vagina. It is usually performed in an outpatient procedure under local, regional or general anesthesia and takes about an hour.
"TOT has no risk of bowel injury and a very small risk of bladder perforation," Dr. Siddiqui says. "Urinary retention and new onset bladder spasms that can happen with other slings are also minimal. It also has fewer complications than open abdominal surgery, including less time in the hospital and less pain."
In Graf's case, the TOT procedure was just one of five that Dr. Siddiqui performed vaginally. She also removed Graf's uterus and ovaries, repaired a bulging rectum and bladder and repaired a prolapsed vagina.
"I just breezed through it," says Graf about her surgery. "I'm certainly pleased with the outcome. I say 'hallelujah' to it. It's taken that worry out of my life."
