Other Incontinence Procedures

Bladder Neck Surgery

The BNS and MMK are traditionally performed through a transverse incision, just above the pubic bone. Just like a caesarean scar. The surgeon opens the plane of tissue which lies between the back of the pubic bone (in front) and bladder (behind). Sutures are then placed near the bladder neck, passing into the vaginal tissue of the front wall of the vagina. These are then tied either to the back of the pubic bone or to a strong ligament nearby. This elevates the bladder neck. This operation can also be performed via the laparoscope - another minimally invasive technique. Regardless, they all rely on the formation of scar tissue to 'hold' everything in place.
I do not perform the traditional sling procedures which involve passing a sling around the bladder neck. These are made from synthetic material, strips of the patients own rectus sheath or another fibrous structure called the fascia lata (in the leg). I cannot comment on its reliability or complications in any depth but it is more 'invasive' than either the BNS or MMK procedure.

Urethral Support Surgery

I have performed each of these and prefer the TVT. This is partly due to user experience and partly related to the tape used by each device. As I currently achieve good results, I have no reason to change.
Para-Urethral Injections  
A small percentage of patients are unsuitable or unable to have surgery. Bulking agents can be injected around the bladder neck and beside the urethra to help reduce leakage.

Prolapse Surgery
This is not in itself continence surgery and may make continence better or worse. The outcome is dependent on a host of factors. Prolapse surgery may be required to restore anatomy to a point where a continence operation will be more effective / successful. 
Vaginal Hysterectomy

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