| Continence -
These are used for stress incontinence. They help strengthen the muscles that surround the urethra. This relies on teaching you how to do the exercises then having you practice twice daily for a 12 week course. -
Some people cannot contract the muscle or have difficulty identifying the muscle. This can be taught in the office over a number of sessions by placing sticky surface electrodes near the vaginal opening and having you squeeze. The strength of the squeeze will be seen on a TV screen. -
This is a simple and effective for some patients with urge incontinence. A technique called "timed voiding" (urinating on schedule) is used.
The above three treatments are combined into a very effective office-based physiotherapy program called Incon. This involves a 6-week training program including a home biofeedback monitoring device. -
This is a useful way to teach Kegel exercises. The set consists of five weights the size of a tampon. These are placed in the vagina and help you identify the muscle and allow you to perform Kegel exercises correctly. -
For those people who still cannot identify the muscle, a probe can be placed in the vagina and the muscle electrically stimulated (non-painful). This is also useful for urge incontinence. -
These are typically used for patients with urge incontinence. The particular one chosen depends on your symptoms, age and existing health problems. Newer drugs have fewer side effects, and can be very effective. Detrol and Ditropan XL are for urge incontinence. Medications for stress incontinence are usually not effective, but may provide relief in some patients. These include Entex LA, Contac, Ornade, and Imipramine (Tofranil). -
There are a number of experimental and approved devices used for controlling stress incontience. At the present time these have not proven effective for many patients. Progress is slow, but ongoing. -
There are many different shapes and sizes. They are generally used for prolapse and occasionally stress incontinence. They have to be fitted by a doctor. -
This is a very new modality for treatment of urge and stress incontinence. There continues to be considerable publicity about this product, but long-term effectiveness is unknown.
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This procedure is performed in the outpatient department without sedation. A cystoscope is placed into the bladder through the urethra. A small flexible needle is placed through a guide in the cystoscope channel. The urethral tissue distal to the bladder neck is visualized, and a needle is passed into the tissue, which causes some sharp discomfort. Local anesthetic is injected to numb the area, and then the Collagen material (a gel substance) is injected into the uretheral tissues until the bladder neck closes. A second injection is made opposite the first. Occasionally 3 or 4 injection sites are used to satisfactory bulk up the tissues and restore continence. You are asked to void after the procedure (usually difficult because there is no feeling) and have previously been taught how to catheterize yourself. Instructions and medications are given prior to going home. You may drive yourself home. -
This procedure is performed in the outpatient department without sedation. A telescope is placed into the urethra, and a needle is passed next to the urethra through the numb area of the tissue to the area of the bladder neck (proximal urethra). Local anesthesic is injected, followed by Collagen, on either side of the urethra. The urethra and bladder neck should close as the injection is completed. You are asked to void after the procedure (usually difficult because there is no feeling), and have previously been taught how to catheterize yourself. Instructions and medications are given prior to going home. You may drive yourself home. -
This procedure for stress incontience is performed in the operating room under local anesthesia. It has up to a one-day hospital stay, and is 85% effective.
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A laparoscopy is performed by distending the abdomen with carbon dioxide gas and making four small incisions. A telescope is placed under the umbilicus and 3 channels (operating ports) are placed in the lower abdomen through which instruments are placed in order to perform the procedure. Sutures are placed in the strong tissue of the vagina and surrounding structures in order to restore the hammock like support to the urethra and bladder neck. The sutures are secured in a tough fascia ligament, named Cooper's ligament. The four sutures are permanent, and therefore do not dissolve. They are tied internally and are very secure. A suprapubic catheter is placed into the bladder through the lower abdominal skin, after the bladder has been examined to be sure there is no injury to it or to the uterus. Patients may be instructed in self-catheterization instead of using the suprapubic catheter. A small transverse (horizontal) incision, 2 to 4 inches in length, is made just above the pubic bone. The tissues in front of the bladder are exposed until the urethra and bladder neck are in view. Permanent sutures are placed in the strong vaginal and surrounding tissues and secured in the strong ligament (Cooper's ligament) attached to the pelvic bone. When these sutures are tied, a strong tissue hammock is formed under the urethra and bladder neck. The bladder is inspected to rule out damage to it or to the ureters. A catheter is left in the bladder through the lower abdominal skin, or the patient performs self-catheterization. A strong piece of fascia (covering of the muscle) may be harvested from the outer aspect of the thigh, using a small incision, with an instrument called a Fascial Stripper. A second length is also obtained, and these are sutured together to form a long piece of material with a wide portion in the center. The leg incision is 3 to 4cm or 1 1/2 inches in length. Alternatively, a donated portion of fascia lata tissue may be used instead of your own tissue. This decision is made prior to the operation. A small incision is made in the lower abdomen (3 to 4cm or 1 1/2 inches) where the tails of the sling will be attached to this strong abdominal fascial tissue. An incision is made in the vagina in order to expose the urethra and bladder neck over which the sling is be placed. Tunnels are made from the vagina to the abdomen, and these pass in front of the bladder. The sling material is passed from the vagina to the abdomen on each side of the urethra, and then sewn into position so it will not slip. The tails are secured to the strong abdominal fascia. The bladder is inspected to ensure that no damage has occurred to the ureters or bladder wall. The vaginal incision is closed and a vaginal pack is left in place. The abdominal incision is closed.
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