Bladder surgery is a medical intervention using surgical procedures to correct problems involving the bladder, the organ that stores urine before its exit through the urethra. Surgical techniques are used to repair damage, treat cancer, correct incontinence problems and fix conditions such as bladder prolapse. Procedures range from minimally invasive techniques that treat incontinence to bladder removal surgery after other interventions for severe incontinence or bladder cancer have failed. Surgery also is used for bladder stone removal and implantation of artificial urinary sphincters.
Surgeries to treat incontinence are generally reserved for cases that don’t respond to nonsurgical treatments. The least invasive procedure involves injection of a bulking agent into tissues around the urethra to decrease urine leakage. This can be done in a doctor’s office and requires minimal anesthesia. The procedure might need to be repeated to maintain effectiveness.
Retropubic suspension is a surgical, tension-free sling technique used only with women. It lifts the bladder neck and urethra to relieve stress incontinence. This procedure accesses the bladder through an incision in the vagina and requires hospitalization. The sling supports the bladder, attaching to the pubic bone or ligaments. This helps keep the urethra closed when stressed by pressure during sneezing or laughing.
Another effective surgical treatment for stress incontinence is conventional sling surgery, which uses either synthetic material or the patient’s own tissue to create a supporting sling to reduce pressure on the urethra. Incisions in both the vagina and abdomen are required. Sling techniques are long-term solutions to incontinence that are used when other methods have failed to produce results.
Overactive bladder surgery is utilized only in severe cases where other treatments have not been effective. Bowel tissue can be added to the top of the bladder to increase its volume in the major abdominal surgery, bladder augmentation. An artificial urinary sphincter can be surgically implanted to replace a defective sphincter that no longer stops the flow of urine from the bladder. Bladder removal is reserved for the most severe cases. After bladder removal surgery, a bag to collect the urine replaces the bladder’s function.
Bladder stones occur more frequently in men than in women, and they contribute to infections and incontinence. Surgery might be used to remove the stone. Bladder surgery also can correct urethra and bladder prolapse.
Surgical treatments for bladder cancer depend on the invasiveness of the cancer. Tumors that have not spread to the outer wall of the bladder can be treated with trans-urethral bladder surgery. This technique, using a wire loop on a tube inserted through the urethra, is also used to remove calcifications in the bladder, to collect tissue samples or to examine the urethra and bladder. Invasive bladder cancer — cancer that has spread deep into the bladder wall — might require removal of the entire bladder.