Editing Urinary incontinence (section)

===Surgery===
Women and men that have persistent incontinence despite optimal conservative therapy may be candidates for surgery. Surgery may be used to help [[Stress incontinence|stress]] or [[overflow incontinence]].<ref name=Mayo2008/> Common surgical techniques for stress incontinence include [[Urethral sling|slings]], tension-free vaginal tape, bladder suspension, artificial urinary sphincters, among others.<ref name=Mayo2008/> It is not clear if [[antibiotic]]s taken [[prophylactically]] after surgery are helpful at decreasing the risk of an infection after surgery.<ref>{{cite journal | vauthors = Temtanakitpaisan T, Buppasiri P, Lumbiganon P, Laopaiboon M, Rattanakanokchai S | title = Prophylactic antibiotics for preventing infection after continence surgery in women with stress urinary incontinence | journal = The Cochrane Database of Systematic Reviews | volume = 2022 | issue = 3 | pages = CD012457 | date = March 2022 | pmid = 35349162 | pmc = 8962651 | doi = 10.1002/14651858.CD012457.pub2 | collaboration = Cochrane Incontinence Group }}</ref>

The use of transvaginal mesh implants and bladder slings is controversial due to the risk of debilitating painful side effects such as vaginal erosion.<ref>{{Cite news|url=https://www.lieffcabraser.com/injury/devices/vaginal-mesh/|title=Vaginal Mesh & Bladder Sling Complications and Lawsuits|work=[[Lieff Cabraser]]|access-date=2018-05-10}}</ref> In 2012 transvaginal mesh implants were classified as a high risk device by the US Food and Drug Administration.<ref>{{Cite web|url=https://www.theguardian.com/society/2017/aug/31/vaginal-pelvic-mesh-explainer|title=What does pelvic mesh do and why are women suing over it? – explainer | vauthors = Davey M |date=2017-08-31 |website=the Guardian |access-date=2018-05-10}}</ref> [[Urodynamic testing]] seems to confirm that surgical restoration of vault prolapse can cure motor urge incontinence.

Traditional suburethral sling operations are probably slightly better than open abdominal retropubic colposuspension and are probably slightly less effective than mid-urethral sling operations in reducing urinary incontinence in women, but it is still uncertain if any of the different types of traditional suburethral sling operations are better than others.<ref name="Saraswat2020">{{cite journal | vauthors = Saraswat L, Rehman H, Omar MI, Cody JD, Aluko P, Glazener CM | title = Traditional suburethral sling operations for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 1 | issue = 1 | pages = CD001754 | date = January 2020 | pmid = 31990055 | pmc = 7027385 | doi = 10.1002/14651858.CD001754.pub5 }}</ref> Similarly, there is insufficient long term evidence to be certain about the effectiveness or safety of single-incision sling operations for urinary incontinence in women.<ref>{{cite journal | vauthors = Carter E, Johnson EE, Still M, Al-Assaf AS, Bryant A, Aluko P, Jeffery ST, Nambiar A | display-authors = 6 | title = Single-incision sling operations for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2023 | issue = 10 | pages = CD008709 | date = October 2023 | pmid = 37888839 | pmc = 10604512 | doi = 10.1002/14651858.CD008709.pub4 }}</ref> Traditional suburethral slings may have a higher risk of surgical complications than minimally invasive slings but the risk of complications compared with other types of operation is still uncertain.<ref name="Saraswat2020" />

[[Laparoscopy|Laparoscopic]] colposuspension (keyhole surgery through the abdomen) with sutures is as effective as open colposuspension for curing incontinence in women up to 18 months after surgery, but it is unclear whether there are fewer risk of complications during or after surgery.<ref name="Freites_2019">{{cite journal | vauthors = Freites J, Stewart F, Omar MI, Mashayekhi A, Agur WI | title = Laparoscopic colposuspension for urinary incontinence in women | journal = The Cochrane Database of Systematic Reviews | volume = 2019 | issue = 12 | pages = CD002239 | date = December 2019 | pmid = 31821550 | pmc = 6903454 | doi = 10.1002/14651858.CD002239.pub4 | collaboration = Cochrane Incontinence Group }}</ref> There is probably a higher risk of complications with traditional suburethral slings than with open abdominal retropubic suspension.<ref name="Freites_2019" />
[[File:Artificial urinary sphincters.jpg|alt=artificial urinary sphincter|thumb|250x250px|AMS 800 and ZSI 375 artificial urinary sphincters]]
The [[artificial urinary sphincter]] is an implantable device used to treat stress incontinence, mostly in men. The device is made of 2 or 3 parts: The pump, cuff, and balloon reservoir connected to each other by specialized tubes.  The cuff wraps around the urethra and closes it. When the person wants to urinate, he presses the pump (implanted in the scrotum), to deflate the cuff, and allow the urine to pass. The cuff regains pressure within a few minutes to regain continence.<ref>{{cite journal | vauthors = Downey A, Inman RD | title = Recent advances in surgical management of urinary incontinence | journal = F1000Research | volume = 8 | pages = 1294 | date = 2019-07-31 | pmid = 31448082 | pmc = 6676503 | doi = 10.12688/f1000research.16356.1 | doi-access = free }}</ref> The [[European Association of Urology]] considers the artificial urinary sphincter as the gold standard in surgical management of [[Stress incontinence|stress urinary incontinence]] in men after [[prostatectomy]].<ref>{{Cite journal| vauthors = Burkhard FC, Bosch JL, Cruz F, Lemack GE, Nambiar AK, Thiruchelvam N, Tubaro A, Ambühl D, Bedretdinova DA, Farag F |title=EAU Guidelines on Urinary Incontinence in Adults|url=https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urinary-Incontinence-2018-large-text.pdf|journal=European Association of Urology}}</ref>