Stress Incontinence in Women – Dr. Paul R. Kenworthy, M.D.

Stress Incontinence in Women – Dr. Paul R. Kenworthy, M.D.


– Hello, my name is Dr. Paul Kenworthy and I’m a urologist here at
Northwoods Urology of Texas and today we’re gonna
talk a little bit more about stress urinary incontinence. (upbeat music) Last time we talked quite a
bit about urinary incontinence of all types and we know
the significance of this in the United States and
today we’ll talk a little more about stress urinary
incontinence in women. It’s the involuntary
loss of urine associated with physical increases
in abdominal pressure. On the initial evaluation, this will include your personal history, physical examination at which
time a pelvic examination will be performed. Commonly we’ll perform this
and we’ll attempt to evaluate for incontinence occurring. Also an assessment of
post-void urinary residual is commonly done by a little
bladder scan instrument. In some circumstances, we may have to perform an
in-and-out catheterization through the urethra to drain the bladder and to check the urine and also assess for residual urine in the bladder. After that evaluation,
depending on your history, at times further evaluations
may include cystoscopy, or further evaluation by a urodynamic assessment
could be recommended, but not routinely
necessary for most patients with more straight forward
stress urinary incontinence. Additional evaluations at
times may be recommended if the specific cause or type of incontinence is unclear or uncertain, and if confirmed stress
incontinence is not demonstrated on initial examination, or
if the patient has other or mixed incontinence
including urinary urgency which raises the question
of a different cause of the incontinence being
more prevalent or more common. Sometimes if patients have
a high post-void residual, or amount left in their bladder,
or prior surgical failures or even recurrent incontinence having previously been treated, further evaluation may be warranted. But after the initial
evaluation is completed and the patient’s coming to
a definitive treatment plan, there are non-surgical
treatments that can be addressed. A continence pessary, vaginal inserts for urinary incontinence, pelvic floor muscle
therapy or Kegel exercises, BTL or Emsella therapy
which is a non-invasive, electromagnetic stimulation of
the pelvic floor musculature for the purposes of rehabilitation of weak pelvic floor muscles, restoration of neuromuscular
control for the treatment of female and male urinary incontinence. Those are fairly simple and
non-invasive treatments. Surgical treatments
include bulking agents, mid-urethral sling which
are either retropubic or transobturator in approach. Single incision slings
are newer and may be used in select patients, but
overall the efficacy and safety data are not as
well-defined as the others. There are a number of
potential benefits to use of mesh slings for incontinence, but there are also some
risks associated with these. Now I’m gonna list these risks and these are very commonly described and many of them may be inherent to other surgical treatments for stress incontinence procedures so don’t let this put you off
but I think it’s important that you hear some of this. Some of the problems that
occur with sling procedures, including mesh sling procedures
are pain or discomfort, swelling caused by fluid retention, erythema or redness of
the skin, infection, bleeding in the area, either vaginally or at the sling insertion site, scarring or mesh erosion
which is the presence of mesh material within the organs surrounding the vaginal
area, or mesh extrusion which is kind of the
body rejecting the mesh, fistula formation would be extremely rare, which is an abnormal communication
between two structures, foreign body responses which is a reaction to the mesh itself, urinary incontinence or
involuntary leakage of urine or overactivity can occur
with many sling procedures, not infrequently. Urinary retention, making
the sling too tight. That’s inherent with any sling
product but again very rare. Voiding discomfort or disfunction,
difficulty with urinating can occur after a sling procedure or really any incontinence procedure. Vaginal discharge can occur, nerve damage or again bladder instability. Sometimes after you
operate around the bladder, you may develop more urgency of urination for a period of time and
sometimes this is prolonged. The sling can migrate which
would be again extremely rare. Dyspareunia or pain with vaginal intercourse
has been described with mesh sling procedures
and other vaginal procedures. So the alternatives to
mesh slings also include other slings using the
patient’s own fascia, commonly termed it pubovaginal sling. We obtain the fascia
from the suprapubic area or below the belly button
or sometimes from the thigh. This does carry with
it some added morbidity including pain, separate
incisions to harvest the material. An alternative to this is
a bladder neck suspension. The common one that’s a part
of normal guideline criteria is called a Burch culposuspension. And that does not involve the use of mesh. Now each of these
treatments can be effective for your incontinence and
the risks and benefits of each of these, along
with your overall history and exam findings, will determine
which surgical treatment you may end up selecting, along with your urologist or doctor. (upbeat music) At Northwoods Urology, we
understand the importance of urologic health. Visit our website for more tips
about urinary incontinence. If you suffer from any of these symptoms and would like a professional approach, contact our office for an appointment.

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