Surgical Options for Overactive Bladder

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Do you often feel like you need to go to the bathroom immediately? Overactive bladder (OAB), characterized by the urgent need to urinate, can be inconvenient and annoying and can impact your quality of life. It can also lead to certain health complications, such as infections.

If lifestyle changes and medications haven’t worked to treat your OAB, you may want to consider surgery. But take note: Surgical options come with significant risks and side effects, so be sure to weigh your options carefully.

It’s a good idea to talk with a specialist before you seriously consider surgery. He or she can confirm that your symptoms are due to OAB and not another medical condition.

In general, you should look into surgery only after trying lifestyle changes and medication. These therapies aren’t permanent, unlike most surgeries, and they carry few risks. You may need to try more than one medication to find the right one for you.

Before you make any decisions, consider the pros and cons of surgery compared with more conservative treatments. The American Urological Association recommends surgery only in extremely rare cases due to the risks associated with OAB procedures.

If you and your doctor decide to move forward with surgery, you will have several options to consider.

The least invasive surgical procedure for OAB focuses on the nerves that control the bladder. In people with OAB, these nerves can be hyperactive. Electrical stimulation treatments can help them work more normally. This category of treatments is known as neuromodulation therapy. Some types, but not all, require surgery.

The surgical nerve stimulation option is called sacral neuromodulation (SNM). For SNM therapy, a stimulator is implanted under the skin of your abdomen and it acts like a sort of pacemaker for your bladder. The stimulator delivers electrical signals to the sacral nerve—the nerve that transmits signals between the spine and the bladder. These electrical signals override the hyperactive nerves associated with OAB and help regulate bladder function.

Before implanting the stimulator, a doctor will place a wire close to the sacral nerve through a small incision and stimulate it externally to see how well the therapy works for you.

Bladder reconstruction aims to increase the volume of liquid that the bladder can hold. There are two main types of bladder reconstructive surgery:

• Augmentation entero-cystoplasty. In this procedure, a surgeon cuts a slit into the bladder wall and inserts a piece of bowel to increase the size of the bladder. Unfortunately, the surgery has a high rate of complications. Side effects include recurring urinary tract infections, and kidney and metabolism problems.

• Detrusor myectomy. This surgery removes some of the muscle from the inside of the bladder while leaving the bladder wall intact. This increases the size of the interior of the bladder. Patients who have had this surgery have experienced inconsistent results.

Be sure to talk with your doctor about all of your treatment options. Before deciding to have surgery, ask your surgeon about:

• Risks of the operation: Be sure you are comfortable with accepting these risks.

• Your surgeon’s qualifications: A surgeon who is board certified or a Fellow of the American College of Surgeons (F.A.C.S.) has met certain quality and ethical standards.

• A second opinion: Your doctor should be able to refer you to another expert so you can get his or her take on your options.

Together, you and your doctor can determine the best solution for your OAB symptoms.

• If lifestyle changes and medications haven’t worked to treat your overactive bladder (OAB), surgery is an option—but it does come with significant risks and side effects.

• The least invasive surgical procedure for OAB, nerve stimulation therapy, focuses on the nerves that control the bladder.

• You may also opt for bladder reconstructive surgery to treat your OAB.

• Be prepared to talk with your doctor about your treatment options, including surgery.