Dr. Shaw and Dr. Law have seen many men and women over the last decade with stress incontinence. The evaluation and management has had huge advances over that time, and the results have often shown dramatic improvement of the people he has treated.
Many times, treatment does not require medication or surgery. Pelvic floor biofeedback/physical therapy along with lifestyle-dietary changes can be significant. Urologists Dr. Koushik Shaw and Dr. Lawrence Tsai, team up with Dr. George Shashoua, a well respected Austin Uro-Gynecologist, to provide the ONLY Austin and Central Texas team to work under one roof to provide the best of two specialties to achieve optimum results.
Urinary Incontinence Information
What can be expected under normal conditions?
What is urinary incontinence?
What is the cause of incontinence?
What are the various types of urinary incontinence?
How is the diagnosis made?
What are the treatment options for stress incontinence in women?
- Behavioral Modification: Mild to moderate stress incontinence in the female is treated initially with behavior modification. Decreasing the volume of fluid ingested as well as eliminating caffeine and other bladder irritants can help significantly. Timed voiding can be helpful in preventing accidents by scheduling frequent trips to the toilet before leakage occurs.
- Pelvic Floor Muscle Training: Strengthening or Kegel exercises can fortify the pelvic floor and sphincter muscles and improve urinary control. These exercises include repeated contractions of isolated muscles several times a day. Sometimes techniques including biofeedback, electrical stimulation of the pelvic muscles, and weighted vaginal cones can be helpful in teaching the patient how to isolate these muscles.
Surgical Treatment Surgical treatment depends on severity of symptoms as well as any anatomical abnormalities noted on the pelvic exam. Different procedures are aimed at correcting different types of defects. If the only symptom you have is stress incontinence (leakage with exercise, coughing, laughing, etc.), the urethral sling or bulking injections may be appropriate. If you also have bladder prolapse, the bladder itself will need to be lifted back into position. Read below for more detail on these different surgeries.
- Mid-urethral Sling: The most common and most popular surgery for stress incontinence is the sling procedure. These may also be referred to as a TVT or TOT (transvaginal tape, and transobturator tape). In this operation a narrow strip of material is used either from: cadaveric tissue (from a cadaver), autologous tissue (from your own body), or soft mesh (synthetic material). The most common type of sling used is the mesh sling. It is applied under the urethra to provide a hammock of support and improve urethral closure. The operation is minimally invasive, completed through the vagina, and patients recuperate very quickly. It is completed outpatient and under general anesthesia. For many years it was thought that biologic materials, the patient’s own fascia or cadaveric fascia, would create better more sustainable outcomes. We have found however that synthetic meshes have both the ease of use with no need for harvest as well as superior long term results.
- Periurethral Injections: One of the surgical treatments for this condition, used in both males and females, is urethral injections of bulking agents to improve the coaptation of the urethral mucosa. The injections are done under local anesthesia with the use of a cystoscope and a small needle. Bulking material is injected into the urethral submucosal layer under direct vision. Unfortunately, the cure rate with this treatment is only 10 to 30 percent despite multiple formulations on the market for use. This treatment can be repeated and sometimes acceptable results are seen after multiple injections. The operation is minimally invasive but the cure rates are lower compared to the other surgical procedures.
- Bladder Prolapse/ Cystocele Repair: This is completed if the bladder is not emptying well and out of its normal position. Many patients will have urgency or urge incontinence with this type of defect. A synthetic mesh is used to provide support to anterior vaginal wall where the bladder sits. Most of the time this can be accomplished through the vagina, however, we also utilize the Da Vinci Surgical Robot to complete the surgery through the abdomen. The potential adverse outcomes of surgical treatment include bleeding, infection, pain, urinary retention or voiding difficulties, de novo urgency, recurrent pelvic organ prolapse, and failure of the surgery to fix the leakage. With the use of mesh materials there is a very small risk of erosion of the material into the bladder, urethra or vagina.