Dr. Cornella describes how urinary incontinence is treated.
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Possible Treatments for Urinary Incontinence What Causes Urinary Incontinence? Jeffrey L. Cornella: The causes of female urinary incontinence would primarily relate to aging and childbearing. There are patients who have never had children who have problems with urinary incontinence or prolapse, but certainly, vaginal delivery can contribute to the incidents and prevalence of urinary incontinence. There may be other associated conditions as well. An example may be obesity. So, as the patient gains weight, there’s more pressure on the bladder and they increase the tendency toward developing incontinence because it really is affected by pressure. How is Urinary Incontinence Treated And What Is The Most Effective Treatment For Older Women? Jeffrey L. Cornella: In order to treat female urinary incontinence, we have to treat the underlying mechanism. So, the patient sees the physician; they go through a history, which is very important, physical examination and then in some situations, testing. When the patient then has a diagnosis of stress urinary leakage, we address that specifically. When they have bladder overactivity, we address that and most commonly, most patients have a combination of the two issues and thus, the treatment involves addressing each of those two mechanisms. We treat bladder overactivity primarily with bladder retraining and medications. Medications are slightly problematic in that there are studies which show that after six months, approximately 71% of patients will discontinue the medications. That relates to expense. It also relates to dry mouth which many people experience. One of the exciting new modalities of treatment relates to neuromodulation. We can stimulate the nerves that go to the bladder and see improvement in patients. In fact, there’s been a recent study by Kenneth Peters which show that it is commensurate with medications in terms of efficacy without the side effects such as dry mouth. We treat urinary stress leakage primarily by trying to increase the resistance of the urethra. If a patient’s urethra is well supported, in that setting we will do periurethral injection. In the operating room under sedation or in the office depending on the physician’s setup, the patient will receive an injection of a material into the junction between the bladder and the urethra. That results in the bulking of that junction. Many patients will see an improvement and the failure rate are estimated to be approximately 15%. If a patient has poor support of the urethra, that patient is a candidate for re-support of the urethra via surgery. Overflow incontinence is where the bladder is not emptying adequately and thus, the patient has a smaller working volume as they go about their daily activities and it results in contraction and loss of urine. If a patient has urinary retention, it’s important to get the bladder empty. That may be done through self-intermittent catheterization or it may be done through neuromodulation. One of the great advances in recent years has been the ability to stimulate the nerves that go to the bladder. We do that primarily by stimulating nerves along the area of the ankle that’s called posterior tibial nerve stimulation or by actually implanting a pacemaker which stimulates in the area of the sacrum. There are patients who may have a combination of bladder overactivity and urinary retention and each of those two conditions may improve with sacral nerve stimulation. That’s because we are treating the sensory side of the issue and not the motor side. These new modalities of treatment offer benefits to patients who have failed all other modalities of treatment. When we treat patients who have stress urinary incontinence and who have decent of the urethra, we utilize surgery. The most common surgical procedure in that group of patients would be something called a sling procedure. So, the urethra is supported by a synthetic material. It has little fenestrations or openings and as the patien
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