Health: No longer to be caught short: A new surgical procedure can alleviate stress incontinence in women, says Olivia Timbs

MILLIONS of women suffer from some degree of stress incontinence, the involuntary leakage of urine from the bladder. Some will benefit from pelvic floor exercises that strengthen vaginal tone and can alleviate the problem, but for more intractable cases, an operation is necessary. Surgeons can now carry out the procedure by laparoscopy - in which two or three tiny cuts are made in the abdomen - with great advantages for the women concerned.

The condition is so called because when the bladder is stressed - if a sufferer laughs, coughs, plays tennis or jogs - her bladder may leak. Sometimes a trickle of urine escapes, sometimes the bladder gushes. A full bladder contains about 500ml of urine; about 350ml are emptied during normal urination, and while this amount is unlikely to flow after a cough, some women lose so much urine that even heavy pads do not prevent embarrassing stains from appearing .

Stress incontinence can be triggered by childbirth or old age, when the bladder muscles become weaker. Obese women are more vulnerable, as are smokers with chronic heavy coughs. Constipation can also lead to the development of the condition.

The conventional operation involves making an incision along the bikini line, hoisting up the bladder neck, securing it to the ligaments behind the pubic bone and stitching up the incision. The new procedure is known as laparoscopic colposuspension, says Nick Nicholas, a surgeon at the Hillingdon Hospital, in Uxbridge, west London. Last month, Hillingdon, a trust hospital, became one of the first establishments in the country to perform the operation.

When the operation is done laparoscopically, the surgeon makes two small 'keyhole' cuts in the lower abdomen, just big enough to thread a fine telescope through so the internal organs and the surgical instruments - which are controlled outside the body - can be viewed on a screen. The internal surgical procedure is the same as that carried out in the conventional operation.

The advantages for patients are mainly to do with recovery. A woman is unlikely to have to stay in hospital for more than three or four days, perhaps less. A woman who has undergone the conventional operation will be in for at least a week.

The disadvantages of the procedure are mainly technical, Mr Nicholas says. Surgeons are only just learning the skills of laparoscopic operations. They are more 'fiddly' than open ones, and the operation may take as long as two hours, against 40 minutes for a conventional one. A laparoscopic operation will also turn into a conventional one if the surgeon cannot see what he is doing properly, or there is abdominal bleeding.

It is unusual that one of the first operations of this nature should take place at a local hospital trust, rather than a major teaching hospital. But, Mr Nicholas points out, the equipment is not especially expensive and any surgeon could learn to use it. Moreover, as trust hospitals are now competing for patients, any technique that encourages patients to choose them will be welcomed. Although laparoscopic colposuspension takes longer in terms of surgery time, the overall costs are lower because patients spend less time in bed. That fact should gain it support from hospital management.