Three options are available for people who require surgery for overactive bladder when other medical treatments have been unsuccessful. A bladder’s capacity can be increased through surgery, or nerves that control urination can be stimulated to decrease the frequency of voiding and urinary incontinence. The third option is less invasive and involves injections of a drug called onabotulinumtoxinA, which is better known by the brand name Botox®, directly into the bladder. This procedure might have to be repeated regularly. Sedation is required for all three operations.
Bladder augmentation involves removing tissue from the stomach or intestine to enlarge the size of the bladder. This method of surgery for overactive bladder is a major operation and requires several weeks for the patient to recover after being released from the hospital. The procedure is not always successful, and complications could surface, such as perforation of the bladder and bladder cancer. Some patients must use a catheter for the rest of their lives after this procedure.
A less invasive surgery for overactive bladder is called sacral nerve stimulation. The treatment involves implantation of a device similar to a pacemaker under the patient’s skin. The stimulator sends electrical impulses to the nerve that controls urination, essentially blocking messages to urinate that are sent from the brain to the bladder. Many doctors recommend testing the sacral nerve stimulator on the outside of the body to see if it works before performing this method of surgery for overactive bladder.
Sacral nerve stimulation is an outpatient surgery done under general anesthesia. Recovery time is estimated at three weeks. The nerve stimulator can function in the body for several years before replacement is necessary. A handheld programmer controls the painless electrical signals sent to the device. Sacral nerve surgery for overactive bladder works for about half of all patients who suffer from severe urinary incontinence.
OnabotulinumtoxinA injections to treat bladder problems have proven quite successful but are considered experimental in some regions. When this purified toxin is injected directly into the bladder muscle, it produces temporary paralysis of the organ. Patients receive onabotulinumtoxinA injections as an outpatient under local or general anesthesia but might require additional injections after several months. Side effects are rare but include flu-like symptoms or the need for catheterization in a small percentage of patients.
Before considering surgery for overactive bladder, urologists routinely suggest other methods to control urinary incontinence. These methods include pelvic exercises to strengthen bladder control, medication and electrical stimulation of the bladder. Biofeedback is used to help regulate the urge to urinate and to teach the patient how to fully empty the bladder. Some people who have an overactive bladder limit liquid intake and adhere to a regular schedule of elimination to cope with the problem.