Thursday, May 31, 2012
Posted by: Richard Hamilton, MD
If you leak urine with coughing, lifting, laughing, sneezing or any other physical activity, you have stress urinary incontinence. The severity can range from mildly irritating to socially debilitating.
If non-surgical treatments, including pelvic floor muscle strengthening (kegel exercises) or lifestyle changes (weight loss is particularly effective) have not been helpful, don’t give up hope. There are highly effective surgical treatments readily available.
Surgical Mesh in the News
The use of surgical mesh in pelvic support surgery has been in the news over the last several years. The FDA warned consumers of complications again in 2011. Though complications are reported with the use of synthetic mesh to remedy incontinence, the focus of the FDA warning is on the use of synthetic materials in more extensive procedures to address pelvic organ prolapse. Talk to your doctor for more information.
The most common and effective procedure currently performed is known as a “mid-urethral sling.” This is performed as a same-day outpatient procedure, with a short one- to two-day recovery. Also known as a “Tension-free Vaginal Tape” (TVT), it will effectively treat up to 90% of individuals and has a low complication rate (see sidebar for more information). This minimally invasive surgery
involves a small, one-inch incision in the upper vaginal wall that allows the placement of a small ribbon-like strip of polypropylene mesh that cradles and supports the underside of the urethra. You are allowed to resume your normal activities almost immediately; however, sexual activity should wait for three to four weeks.
An older type of surgery to treat stress urinary incontinence is the retro-pubic suspension, commonly known as a “bladder lift” or Burch procedure. It is performed less often now, but is still an option. This type of surgery requires a transverse abdominal (bikini line) incision and placement of sutures that support the bladder neck and attach to ligaments behind the pubic bone. This procedure may be preferred if an open abdominal incision is required for other work, such as an open abdominal hysterectomy. It is less effective overall with a 65-75% cure rate.
A final option, usually reserved for cases whether either of the above procedures have failed, is the use of trans-urethral bulking agents. Specific materials are available that are injected around the uretheral sphincter muscle (bladder neck) that separates the bladder from the urethra. This is also performed on an outpatient basis but may require multiple ongoing treatments to remain effective.
The impact of urinary incontinence is different for each woman, and is not usually a common topic of conversation amongst friends. If you feel you are affected by this condition, discuss it with your physician, as there are effective options available to help you.
If you are considering surgery, ask your doctor about his or her experience with the procedure they recommend, as well as what you can expect in terms of outcomes. If you are not comfortable asking your surgeon these questions or are not comfortable the answers you receive, it is always best to get a second opinion.
At Women's Healthcare Associates, our OB/GYN physicians and gynecologists are also surgeons experienced in many surgical techniques and approaches, including urogynecology. Contact one of our offices to make an appointment for an evaluation or surgical consultation. >
Richard Hamilton, MD is a board-certified OB/GYN physician and surgeon who sees patients at the Eastbank and Tabor offices of Women’s Healthcare Associates. He received his medical degree from Jefferson Medical College in Philadelphia, Pennsylvania before completing his OB/GYN residency at Oregon Health & Science University. Dr. Hamilton’s interests include minimally invasive surgery, including robotic surgery, pelvic organ prolapse, and urinary incontinence; hormone replacement; general gynecology and all aspects of pregnancy and prenatal care. He is dedicated to communicating the latest medical science and treatment options in understandable terms.
Sources: Image - Comfort Life