Urinary incontinence in men and women can be troublesome and embarrassing, but it is treatable. There are several types of incontinence, but the most common are urinary urge incontinence, stress incontinence, and mixed incontinence. Incontinence is a very common condition and the prevalence does increase as one ages. Urinary urge incontinence involves the involuntary loss of urine usually associated with a sudden urge that cannot be suppressed. Some of the causes may be related to infection, hormone status, childbirth, or previous pelvic surgeries. A thorough history and comprehensive pelvic floor exam are vital. Not only is it important that the physician know all of the medications that the patient is taking, but it is equally important to know the toilet habits and dietary habits. It can be exacerbated by certain types of foods/beverages. A urinalysis is needed to rule out an infection. Further testing either with urodynamics or cystoscopy or both may be needed.
Treatments for Urinary Urge Incontinence
- Symptoms that a woman may experience include:
- Behavioral Changes- This includes weight loss, smoking cessation, and pelvic floor muscle therapy.
- Botox- This is an In-office treatment, that uses Botox to calm that nerves that trigger the overactive bladder muscles, that cause incontinence.
- Dietary Changes
- Pharmacological- This involves a trial of medications that are known as anticholinergics. It is important that the patient is aware of the side effects of medications. If the medications are not helpful or cannot be taken, then other surgical modalities are investigated
- Physical Therapy- Pelvic floor muscle therapy
- Axonics Therapy – Axonics® Therapy is a clinically proven solution that provides gentle stimulation to the nerves that control the bowel and bladder. This type of stimulation can restore normal communication between the brain, the bladder, and the bowel, which can result in an improvement of symptoms related to an overactive bladder, fecal incontinence, or urinary retention. The Axonics® therapy system is designed to work for up to 15 years in regular therapeutic treatments.
- Interstim Therapy – The therapy uses a small, implanted medical device to send mild electrical pulses to a nerve located just above the tailbone. This nerve, called the sacral nerve, controls the bladder and surrounding muscles that manage urinary function. The electrical stimulation may eliminate or reduce bladder control symptoms. Interstim therapy does not treat symptoms of stress incontinence.
Stress Urinary Incontinence
Stress incontinence is the involuntary loss of urine associated with physical activity such as coughing, sneezing, and exercising. It is caused by several factors some of which may be childbirth and previous pelvic surgeries. As many as 50% of all women experience symptoms of stress urinary incontinence. As with urinary urgency incontinence, a thorough history and physical exam is crucial.
Treatments for Stress Incontinence
- Kegal Exercises
- Dietary Modification / Times Voiding
- Non-mesh Option
- Bulking Agents
Small fistulas may sometimes resolve with a foley catheter drainage. However, the majority of times, surgical treatment is needed. Depending on the location of a fistula, the physician may repair the defect either vaginally or abdominally. Trained physicians can repair this robotically, which greatly minimizes post-operative discomfort.
Urethral Stricture Symptoms
- Blood in the urine
- Difficulty urinating
- Frequent urination
- Painful urination
- Spraying of the urinary stream
- Discharge from the urethra
Diagnosis includes a detailed history and physical including onset of symptoms and severity. Your doctor may also choose to evaluate your urethra with a variety of office tests including:
- Post-void residual volume: determining how well you empty your bladder
- Urinary flow rate: strength of urinary stream retrograde urethrogram: X-ray performed while instilling dye into urethra
- Cystoscopy: looking into the urethra and bladder with a small telescope
Various treatment options exist, each with their own advantages and disadvantages.
Gently stretching the stricture with sequential dilators. Usually performed in the office with local anesthesia, however recurrence rate is high.
The stricture is cut using a special cystoscope while under general anesthesia in the operating room. Typically performed on outpatient basis, and no formal skin incision is needed. Success rate is typically pretty good, but depends on location of the stricture and length of the stricture. Each subsequent incision carries higher recurrence rate.
Removing the diseased segment and replacing with healthy tissue. The technique used depends on location and length of the stricture, as well as surgeon experience. For longer strictures, a tissue graft is usually needed to bridge the gap. The tissue used for grafting can include local penile skin or even buccal mucosa from inside the cheek. Success rates are typically very good with low recurrence rates, especially with surgeons with experience in performing these procedures.
Leakage of Urine with Sexual Intimacy
Men who have undergone radical prostatectomy may have urinary leakage not only with normal day-to-day activities, but may have leakage of urine with sexual activity. Climacturia (leakage of urine with orgasm) and leakage with sexual arousal are not uncommon after the removal of the prostate gland. Men who leak urine with sex are very frustrated. This area is one in which Dr Christine has the largest series of patients successfully treated using an AdVance XP male sling. The cure rate has been truly amazing with over 80% of men with sexual activity induced urinary incontinence completely resolving after sling placement. A minor surgery that takes less than an hour to perform, as an outpatient, can end this embarrassing problem.
Another option to treat urinary leakage with intimacy in men who have had a radical prostatectomy can be a Mini-jupette procedure. This is a different type of sling, placed at the time of a penile implant surgery; so, for men who have ED and climacturia, one surgery can be the road to a return a satisfying life.