Radio Frequency Bladder Neck Suspension: A Treatment for Genuine Stress Incontinence

The third in a three-part series on surgical treatment options for Stress Urinary Incontinence (SUI)

If you suffer from stress urinary incontinence (SUI) you are not alone. This condition affects more than 16.5 million women in the United States and these numbers are growing each year.  More often than not, women who suffer from this condition quietly cope, while their quality of life slowly deteriorates.  It has been said that incontinence doesn't kill you ...it just takes your life away.  Fortunately surgical treatment is now available through several minimally invasive techniques.

SUI is not truly a problem of the bladder; it is actually caused by an improperly functioning urethra. The urethra is the thin, muscular, tube-like structure that runs from the bladder to the outside of your body where urine is expelled.   Normally, a healthy urethra, when properly supported by strong pelvic floor muscles and intact connective tissue, maintains a "water-tight" seal to prevent involuntary loss of urine during physical stress (coughing, sneezing, and lifting).  When a woman suffers from SUI, most often weakened muscles and tissues in the pelvic floor (caused by factors such as childbirth, loss of estrogen and repetitive pelvic muscle straining) are unable to support the urethra in its correct position.  When sudden abdominal pressure, such as that from a cough or sneeze, is exerted on the bladder, the urethra cannot remain closed and urine escapes. 

The urethra is primarily supported by the vagina.  It lies atop of the vagina which acts like a hammock, much like the one you find in the backyard.  The urethra lies on top of this hammock and is supported, like you would be if you were lounging comfortably on the hammock.  Two things provide support while you lie on the hammock: the ropes that tie it to the base (connective tissue) and the strength of the actual canvas (vaginal wall muscle).  When SUI occurs this hammock effect is weakened and can no longer offer the proper support. This results in urine leakage during physical activity such as running, jumping, sneezing or coughing. 

In parts one and two of this series we reviewed a minimally invasive surgical approach for treating SUI called a trans-vaginal tape (TVT) procedure that essentially creates a new hammock for the urethra and a suspension via a laparoscopic burch colposuspension, which you can think of tying "new ropes" to the existing hammock.  Part three will discuss a relatively new procedure called radio frequency bladder neck suspension, which basically causes the hammock to heat shrink.

What is Radio Frequency Bladder Neck Suspension?

Radio frequency bladder neck suspension is a minimally invasive procedure that applies precisely controlled, low-power radio frequency energy to small, precise areas of the supporting tissue of the pelvic floor where continence is controlled.  As the pelvic tissue is heated by this energy, it shrinks and stiffens. The pelvic floor then stabilizes during the normal healing process. Once stabilized, the pelvic tissue is once again able to properly support the urethra allowing it to maintain that "water-tight" seal during stress activities such as coughing or sneezing.

The SURx System

Radio frequency tissue heating has been used in medicine for more than 100 years and is currently used in the treatment of a variety of medical conditions such as back pain, shoulder problems, GI disorders, prostate disease and others.  It is only recently that this mechanism has been applied to incontinence using the SURx system.  This system is the bipolar radio frequency device applicator and the generator that is used in the procedure.  The procedure can be performed laparoscopically or vaginally.

Am I a Candidate for a SURx Procedure?

The SURx procedure is most recommended for women with mild genuine stress incontinence where this is the first course of surgical intervention.  It is also recommended for women desiring future pregnancy.  Only a complete physical examination and consultation with your physician can determine if a radio frequency bladder neck suspension is right for you.  

What Does Recovery Involve?

After the surgery, which is done in an outpatient setting, you will go home in a few hours.  Many patients return to normal daily living activities within a few days and return to non-laborious work in three weeks.  During this time there should be very little interference with daily activities but you will have to avoid strenuous physical activity such as exercise, lifting and intercourse.   Tissue remodeling occurs during these several weeks.  It is important not to stress the tissue before the process is completed, which can be up to eight weeks.

What is the Success Rate?

Clinical trials have demonstrated a one-year success rate of 81% and a three-year rate of 65%.  This change over time suggests some patients may need to be retreated.

 What are the Risks?

This procedure carries a very low risk of surgical complications. The procedure leaves no artificial implants or materials such as surgical mesh, cadaver tissue, bone screws or staples in the body.  In addition, postoperative catheterization is very unlikely.   

Conclusion

Today women are unwilling to accept the limitations on their lifestyle caused by incontinence and are demanding easy, convenient, low-risk treatments.   For some women with this embarrassing and troublesome condition, the SURx procedure using radio frequency energy may be the right answer.

Click here for Dr. Lucente's first article on minimally invasive surgery for SUI.

Click here for Dr. Lucente's second article on minimally invasive surgery for SUI.

For more information on SUI, click here.

Created: 1/8/2004  -  Vincent Lucente, M.D., F.A.C.O.G.