Urinary leakage is a debilitating condition. It is embarrassing. It makes you a prisoner in your own house. It can also be treated.
Urinary leakage has different causes and each different cause requires a different treatment. One type of urinary leakage is called “stress urinary incontinence” or SUI. SUI is not associated with having a bad day at work or from your kids misbehaving; rather, SUI is a type of urinary leakage associated with activity. Some common examples are coughing, laughing, or sneezing. This is also not the type of leakage associated with urgency or that “gotta-go” sensation.
SUI is caused by laxity or weakness of the pelvic floor and as such is a disease that cannot be treated with medicines. The easiest way to treat SUI is with pelvic floor therapy specifically Kegel exercises.
A Kegel exercise done correctly is a subtle tightening of the pelvic floor. An easy way to learn which muscle you should tighten is to practice turning off your urine stream mid-flow. Unfortunately, Kegel exercises do not work for everyone and that is where surgery has a role.
There are currently two types of surgeries for SUI. The first involves injecting some sort of inert (nonreactive) substance in the tissue near the urethra to bulk it up and increase passive resistance. Collagen and Durasphere are common examples of this technique. This is a good first step but most published studies have success rates less than 50% with few if any serious complications.
On the other hand, for more serious cases of SUI, surgery is often the answer. Until recently, the best option for most patients was a simple 15-minute outpatient procedure where a chewing gum sized piece of mesh was placed under the mid-urethra to limit mobility of the pelvic floor. This procedure worked in over 90% of patient but the mesh itself was associated with rare though terrible complications and recent changes by the FDA have made mesh surgery rare. As a result, woman with SUI now must rely in older, less effective and potentially more invasive procedures.
The two options for SUI in the post mesh world are either cadaveric tissue or autologous tissue. Cadaveric tissue is just what it sounds like; the surgeon implants a small piece of sterilized cadaveric tissue under the urethra in a manner similar to the mesh surgery. This technique does not have the same long-term efficacy as mesh but also avoids most of the complications associated with mesh surgery. Autologous tissue is tissue that the surgeon removes from the patient herself usually either from the leg or the lower abdominal area and then implants under the urethra. This has higher success rates than cadaveric tissue but lower than mesh and avoids the use of cadaveric tissue. The problem with autologous tissue is that it must be removed from the patient which adds time to both the surgery and the recovery.
While none of the options for SUI work 100% of the time, for patients who avoid activity for fear of urinary leakage, good options do exist. If anyone has more specific questions, please call my office and I’ll be glad to sit down and talk through all the finer points of this complicated problem.