Urinary incontinence represents a problem with a significant social and economic impact, and its treatment can vary depending on the severity of the condition and the underlying causes. Surgical treatment is reserved for cases where conservative therapies have not been successful. The surgical techniques primarily focus on stress incontinence, the most common form among women. The main techniques include:

• TVT (Tension-free Vaginal Tape):

This procedure is currently the most used technique for addressing stress urinary incontinence in women. It is usually performed under spinal anesthesia and involves the insertion of a polypropylene mesh around the central urethra. The main complications related to the procedure include episodes of urinary retention; the formation of hematomas around the injection sites in the pelvic muscle structures, which usually absorb spontaneously; bladder perforations; and infections.

• TOT (Trans Obturator Tape):

To reduce the frequency of complications associated with the TVT technique, a new surgical methodology known as TOT was introduced in 2001. This procedure involves the insertion of a polypropylene tape through the obturator foramen, using a specific needle in a maneuver that goes from the outside to the inside (the “out-in” technique). In 2003, an evolution of this technique was proposed. Currently, this variant involves using the same polypropylene tape already employed in TVT, applied through specific instrumentation following a path opposite to the previous one. In this case, the tape is placed under the urethra, inserting the needle through a small sub-urethral incision and exiting at a predetermined point at the thigh root (the “in-out” technique). This new technique aims to combine the benefits of a well-tolerated tape, such as that of classic TVT, with a reduction of uretrovesical-vaginal complications guaranteed by the “out-in” TOT. Initial data from follow-ups of this procedure do not seem to indicate significant complications. In both cases, we are talking about minimally invasive procedures, with a fairly rapid recovery: at discharge, patients can resume normal daily activities, provided they avoid excessive physical strain for about a month.

• Artificial Sphincter:

Typically, the use of an artificial sphincter is indicated only in cases of severe incontinence when suspension procedures have been unsuccessful. This procedure is much more complex than the previous ones and is performed under general anesthesia. It involves placing a device known as an artificial sphincter at the level of the bladder neck. This device, consisting of a cuff, a pump that also integrates the valve and resistance, and a reservoir, remains inactive for a period of 4 weeks, after which it is activated. The most concerning complication is an infection of the sphincter, which would require its removal. The choice of surgical treatment must be personalized and discussed in detail. It is important to consider the severity of incontinence, the patient’s general health conditions, and her preferences. Each technique has its own risks and benefits, and the final decision must take individual needs into account. See also: