Stress urinary incontinence
What is stress urinary incontinence?
SUI, in short is the unintentional leakage of urine, especially while laughing, coughing or sneezing (anything that increases the intra abdominal pressure). This is an extremely embarrassing situation for the patient.
What causes stress urinary incontinence?
Difficult, instrumental delivery or multiple pregnancies (combined with genetic factors), chronic urinary infections are the most common causes of urinary incontinence.
What are the treatment options?
For minor anatomic deviations, Kegel’s exercises will be sufficient to strengthen the pelvic floor musculature. This can be performed anywhere, anytime once you master it yourself.
Medical management is useful only if the patient has an associated “overactive bladder” which has a neurogenic component. Once the patient is under our care we will be able to differentiate and pin point the type of urinary dysfunction you are facing and treat accordingly. Some centers infuse collagen around the urethral tissue; this procedure may not deliver effective results (besides being a temporary remedy).
Surgical management is initiated when medical management fails to treat incontinence. There are two very popular procedures.
Laparoscopic Burch suspension:
When a patient with urinary incontinence also has an associated descent of the uterus, a laparoscopic hysterectomy (link) followed by a laparoscopic burch suspension is performed.
This extremely skilled procedure requires the access of the retro pubic space “the cave of ritzeus”, to access the urethra. The para urethral region (around the urethra) is anchored to the cooper’s line (a strong ligament) anteriorly using a mesh or non-absorbable sutures, thus suspending the urethra and restoring the normal anatomy.
Trans Vaginal Tapes / Trans Obturator Tapes:
These are specialized mid- urethral sling mesh, which form a “hammock” underneath the urethra for support. These tapes have become the treatment of choice for patients because they are very minimally invasive, the complete procedure only takes about half an hour and no abdominal incisions are necessary as the whole procedure is performed vaginally. The injury to other organs like bladder and urethra are very minimal in the hands of an expert surgeon. Mesh erosion is the only documented complication of this procedure and it can be easily treated.