Family Health: Robotic surgery relieves urinary incontinence

For millions of women, getting through the day means staying close to a bathroom. Some women carry a change of clothes on outings, and others just stay home. These women have urinary incontinence, a common condition that causes involuntary loss of urine. It can be minor and only slightly bothersome. But it can also be so severe that it keeps women from enjoying their lives.

For the most common type of urinary incontinence – stress incontinence – robotic surgery now helps women get back to their normal lives quickly, with much less pain than with older surgical methods. “Recovery from robotic surgery is much faster, and risks for infection and other complications are lower,” says obstetrician and gynecologist Gary Harvey, who has done nearly 300 pelvic surgeries using the surgical robot.

With stress incontinence, urine leaks during activities such as lifting, coughing, laughing or standing up. One of the most common causes is prolapsed bladder. This happens when the wall of muscular tissue that separates this organ from the vagina becomes stretched or weakened, allowing it to drop from its normal position and sag into the vagina. In this position, the muscles that normally keep urine inside the bladder aren’t able to squeeze as tightly as they should.

Labor and delivery can weaken these muscular tissues, also known as the pelvic floor, and women who have had several children are at higher risk for prolapsed bladder. Heavy lifting also raises the risk, as does chronic coughing, frequent straining during bowel movements and being obese. Falling estrogen levels from menopause also raise the risk.

Prolapsed bladder can also cause the opposite problem – incomplete emptying. Women with this problem, also called voiding dysfunction, may have trouble releasing urine or feel the need to urinate repeatedly. Frequent urinary tract infections are also a sign of voiding dysfunction.

Some mild cases of urinary incontinence and voiding dysfunction can be treated with medicines, and certain exercises and behavior modifications can also help. However, mild urinary problems usually become more severe over time. If symptoms are interfering with your daily life, it’s a good idea to talk with your doctor about getting help. That starts with an examination and assessment to determine if surgery is the right treatment for you.

Expert surgeons choose the procedure that fits each woman’s specific condition, and today the most effective procedures aim at fixing the underlying problem for long-term relief. “Some procedures relieve symptoms temporarily, but they don’t correct the defect,” Harvey says. “The anatomic restorative procedure that we use results in long-lasting improvement in function.”

When this procedure is done with the da Vinci robotic surgical system, that excellent result is accomplished faster and with fewer side effects. The surgeon makes several small “keyhole” incisions to insert the instruments. He or she stands at a console to operate the surgical system, which translates hand movements to instruments inside your body. The surgeon’s view is enhanced by a magnified, high-definition 3D system, and the tiny instruments make smaller, more precise movements than a human hand can accomplish. This procedure is done under general anesthesia and takes about 1 1/2 hours.

Da Vinci surgery for bladder prolapse is an outpatient procedure, and women typically go home the same day or after one night in the hospital. It’s important to avoid lifting or doing heavy housework for the first month after surgery. To get some exercise, start with walking about 10 minutes a day. Ask your doctor about when to start being more active.

Bladder prolapse surgery with the da Vinci robot has a 90 to 94 percent success rate. Women who have this procedure get immediate and lasting relief from urinary incontinence or voiding dysfunction. This is the kind of result that changes lives. “Urinary problems can be very distressing for women,” Harvey says. “After the procedure, we see women who are very happy to have their lives back.”