Urinary Incontinence: Surgical Treatments

  • David James Osborn
  • Elizabeth B. Takacs
  • Karl J. Kreder
  • Melissa Kaufman
  • Roger DmochowskiEmail author


A variety of surgical therapies have been developed for treatment of urinary incontinence. These include various sling procedures, bladder neck suspensions, and injection of bulking agent materials at the bladder neck. Artificial sphincter devices are used primarily in men with stress urinary incontinence. Surgical treatments for urge urinary incontinence include chemodenervation with botulinum toxin injection into the wall of the bladder, placement of neuromodulator devices, or urinary diversion. This chapter reviews the use of surigcal therapies for the treatment of urinary incontinence in older adult patients.


Urinary Incontinence Stress Urinary Incontinence Pelvic Organ Prolapse Stress Incontinence Tension Free Vaginal Tape 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    United States - Age and Sex. American Community Survey 1-Year Estimates. United States Census Bureau. 2009. Available at: Accessed 22 May 2013.
  2. 2.
    Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61:37–49.PubMedCrossRefGoogle Scholar
  4. 4.
    Hannestad YS, Rortveit G, Sandvik H, et al. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of Incontinence in the County of Nord-Trøndelag. J Clin Epidemiol. 2000;53:1150–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Wells TJ, Brink CA, Diokno AC. Urinary incontinence in elderly women: clinical findings. J Am Geriatr Soc. 1987;35:933–9.PubMedGoogle Scholar
  6. 6.
    Resnick NM, Yalla SV, Laurino E. The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med. 1989;320:1–7.PubMedCrossRefGoogle Scholar
  7. 7.
    McDougal WS, Wein AJ, Kavoussi LR, et al. Campbell-Walsh urology. 10th ed. Philadelphia, PA: Saunders; 2011.Google Scholar
  8. 8.
    Sims J, Browning C, Lundgren-Lindquist B, et al. Urinary incontinence in a community sample of older adults: prevalence and impact on quality of life. Disabil Rehabil. 2011;33:1389–98.PubMedCrossRefGoogle Scholar
  9. 9.
    Long MA, Reed LA, Dunning K, et al. Incontinence-associated dermatitis in a long-term acute care facility. J Wound Ostomy Continence Nurs. 2012;39:318–27.PubMedCrossRefGoogle Scholar
  10. 10.
    Bachmann GA, Nevadunsky NS. Diagnosis and treatment of atrophic vaginitis. Am Fam Physician. 2000;61:3090–6.PubMedGoogle Scholar
  11. 11.
    Bergman A, Bhatia NN. Urodynamic appraisal of the Marshall-Marchetti test in women with stress urinary incontinence. Urology. 1987;29:458–62.PubMedCrossRefGoogle Scholar
  12. 12.
    Coombes GM, Millard RJ. The accuracy of portable ultrasound scanning in the measurement of residual urine volume. J Urol. 1994;152:2083–5.PubMedGoogle Scholar
  13. 13.
    Resnick B. A bladder scan trial in geriatric rehabilitation. Rehabil Nurs. 1995;20:194–6–203.CrossRefGoogle Scholar
  14. 14.
    Boscia JA, Kobasa WD, Knight RA, et al. Therapy vs no therapy for bacteriuria in elderly ambulatory nonhospitalized women. JAMA. 1987;257:1067–71.PubMedCrossRefGoogle Scholar
  15. 15.
    Villareal DT, Apovian CM, Kushner RF, et al. Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Am J Clin Nutr. 2005;82:923–34.PubMedGoogle Scholar
  16. 16.
    Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360:481–90.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Auwad W, Steggles P, Bombieri L, et al. Moderate weight loss in obese women with urinary incontinence: a prospective longitudinal study. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1251–9.PubMedGoogle Scholar
  18. 18.
    Wasserberg N, Petrone P, Haney M, et al. Effect of surgically induced weight loss on pelvic floor disorders in morbidly obese women. Ann Surg. 2009;249: 72–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review. Eur J Phys Rehabil Med. 2008;44:47–63.PubMedGoogle Scholar
  20. 20.
    Talasz H, Himmer-Perschak G, Marth E, et al. Evaluation of pelvic floor muscle function in a random group of adult women in Austria. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:131–5.PubMedGoogle Scholar
  21. 21.
    Keegan PE, Atiemo K, Cody J, et al. Periurethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2007;(3):CD003881.Google Scholar
  22. 22.
    Abrams P, Andersson KE, Birder L, et al. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010;29:213–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Bottiggi KA, Salazar JC, Yu L, et al. Long-term cognitive impact of anticholinergic medications in older adults. Am J Geriatr Psychiatry. 2006;14:980–4.PubMedCrossRefGoogle Scholar
  24. 24.
    Hunsballe JM, Djurhuus JC. Clinical options for imipramine in the management of urinary incontinence. Urol Res. 2001;29:118–25.PubMedCrossRefGoogle Scholar
  25. 25.
    Takeda M, Obara K, Mizusawa T, et al. Evidence for beta3-adrenoceptor subtypes in relaxation of the human urinary bladder detrusor: analysis by molecular biological and pharmacological methods. J Pharmacol Exp Ther. 1999;288:1367–73.PubMedGoogle Scholar
  26. 26.
    Khullar V, Cambronero J, Angulo JC, et al. Age related efficacy of the selective beta-3 adrenoceptor agonist mirabegron for the treatment of overactive bladder: pooled analysis of three prospective, randomised phase III studies in patients >65 years. ICS Annual Meeting; 2012 Oct 15–19; Beijing, China. Abstr No 331.Google Scholar
  27. 27.
    Anger JT, Weinberg AE, Albo ME, et al. Trends in surgical management of stress urinary incontinence among female Medicare beneficiaries. Urology. 2009;74:283–7.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Suskind AM, Kaufman SR, Dunn RL, et al. Population-based trends in ambulatory surgery for urinary incontinence. Int Urogynecol J. 2013;24: 207–11.PubMedCrossRefGoogle Scholar
  29. 29.
    Oliphant SS, Wang L, Bunker CH, et al. Trends in stress urinary incontinence inpatient procedures in the United States, 1979–2004. Am J Obstet Gynecol. 2009;200:521.e1–6.Google Scholar
  30. 30.
    Lee J, Dwyer PL. Age-related trends in female stress urinary incontinence surgery in Australia - Medicare data for 1994–2009. Aust N Z J Obstet Gynaecol. 2010;50:543–9.PubMedCrossRefGoogle Scholar
  31. 31.
    Sivaslioglu AA, Unlubilgin E, Dolen I. A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19: 467–71.PubMedGoogle Scholar
  32. 32.
    Hsiao S-M, Chang T-C, Lin H-H. Risk factors affecting cure after mid-urethral tape procedure for female urodynamic stress incontinence: comparison of retropubic and transobturator routes. Urology. 2009;73: 981–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Guerrero KL, Emery SJ, Wareham K, et al. A randomised controlled trial comparing TVT, Pelvicol and autologous fascial slings for the treatment of stress urinary incontinence in women. BJOG. 2010;117: 1493–502.PubMedCrossRefGoogle Scholar
  34. 34.
    Gordon D, Gold R, Pauzner D, et al. Tension-free vaginal tape in the elderly: is it a safe procedure? Urology. 2005;65:479–82.PubMedCrossRefGoogle Scholar
  35. 35.
    Hellberg D, Holmgren C, Lanner L, et al. The very obese woman and the very old woman: tension-free vaginal tape for the treatment of stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:423–9.PubMedGoogle Scholar
  36. 36.
    Barber MD, Kleeman S, Karram MM, et al. Risk factors associated with failure 1 year after retropubic or transobturator midurethral slings. Am J Obstet Gynecol. 2008;199:666.e1–7.Google Scholar
  37. 37.
    Chen H-Y, Yeh L-S, Chang W-C, et al. Analysis of risk factors associated with surgical failure of inside-out transobturator vaginal tape for treating urodynamic stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:443–7.PubMedGoogle Scholar
  38. 38.
    Groutz A, Cohen A, Gold R, et al. The safety and efficacy of the “inside-out” trans-obturator TVT in elderly versus younger stress-incontinent women: a prospective study of 353 consecutive patients. Neurourol Urodyn. 2011;30:380–3.PubMedCrossRefGoogle Scholar
  39. 39.
    Richter HE, Goode PS, Brubaker L, et al. Two-year outcomes after surgery for stress urinary incontinence in older compared with younger women. Obstet Gynecol. 2008;112:621–9.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Anger JT, Litwin MS, Wang Q, et al. The effect of age on outcomes of sling surgery for urinary incontinence. J Am Geriatr Soc. 2007;55:1927–31.PubMedCrossRefGoogle Scholar
  41. 41.
    Hwang IS, Yu JH, Chung JY, et al. One-year outcomes of mid-urethral sling procedures for stress urinary incontinence according to body mass index. Korean J Urol. 2012;53:171–7.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Gerten KA, Markland AD, Lloyd LK, et al. Prolapse and incontinence surgery in older women. J Urol. 2008;179:2111–8.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Lambrou NC, Buller JL, Thompson JR, et al. Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery. Am J Obstet Gynecol. 2000;183:1355–8. discussion 1359–60.PubMedCrossRefGoogle Scholar
  44. 44.
    AUA Guidelines from AUA Website. Available at: Accessed 24 May 2013.
  45. 45.
    Anger JT, Litwin MS, Wang Q, et al. Complications of sling surgery among female Medicare beneficiaries. Obstet Gynecol. 2007;109:707–14.PubMedCrossRefGoogle Scholar
  46. 46.
    Wallace PA, Lane FL, Noblett KL. Sacral nerve neuromodulation in patients with cardiac pacemakers. Am J Obstet Gynecol. 2007;197:94.e1–3.Google Scholar
  47. 47.
    Amundsen CL, Romero AA, Jamison MG, Webster GD. Sacral neuromodulation for intractable urge incontinence: are there factors associated with cure? Urology. 2005;66:746–50.PubMedCrossRefGoogle Scholar
  48. 48.
    Griebling TL. Sacral nerve stimulation in the elderly. Int Urogynecol J. 2010;21 Suppl 2:485–9.CrossRefGoogle Scholar
  49. 49.
    White WM, Mobley III JD, Doggweiler R, Dobmeyer-Dittrich C, Klein FA. Sacral nerve stimulation for refractory overactive bladder in the elderly population. J Urol. 2009;182:1449–52.PubMedCrossRefGoogle Scholar
  50. 50.
    Wallace PA, Lane FL, Noblett KL. Sacral nerve neuromodulation in patients with underlying neurologic disease. Am J Obstet Gynecol. 2007;197:96.e1–5.Google Scholar
  51. 51.
    Amundsen CL, Webster GD. Sacral neuromodulation in an older, urge-incontinent population. Am J Obstet Gynecol. 2002;187:1462–5.PubMedCrossRefGoogle Scholar
  52. 52.
    Booth J, Hagen S, McClurg D, Norton C, MacInnes C, Collins B, Donaldson C, Tolson D. A feasibility study of transcutaneous posterior tibial nerve stimulation for bladder and bowel dysfunction in elderly adults in residential care. J Am Med Dir Assoc. 2013;14:270–4.PubMedCrossRefGoogle Scholar
  53. 53.
    Dmochowski R, Chapple C, Nitti VW, et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol. 2010; 184:2416–22.PubMedCrossRefGoogle Scholar
  54. 54.
    White WM, Pickens RB, Doggweiler R, Klein FA. Short-term efficacy of botulinum toxin A for refractory overactive bladder in the elderly population. J Urol. 2008;180:2522–6.PubMedCrossRefGoogle Scholar
  55. 55.
    Nitti VW, Dmochowski R, Herschorn S, et al. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase III, randomized, placebo controlled trial. J Urol. 2013;189:2186–93.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • David James Osborn
    • 1
  • Elizabeth B. Takacs
    • 2
  • Karl J. Kreder
    • 2
  • Melissa Kaufman
    • 1
  • Roger Dmochowski
    • 3
    Email author
  1. 1.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of UrologyUniversity of IowaIowa CityUSA
  3. 3.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations