Urinary Incontinence / Overactive Bladder
Over 30 million people in the United States suffer from urinary incontinence or overactive bladder (OAB). This condition is far more prevalent in women than men. In the general population, age 15 to 64 years, 10-30% of women, versus 1.5% of men are affected. Those with OAB often experience urgency at inconvenient and unpredictable times and sometimes lose control before reaching a restroom. OAB, therefore, interferes with work, daily routine and intimacy, causes embarrassment, and can diminish self esteem and quality of life.
With (OAB), the bladder muscle contracts spastically, sometimes without known cause, resulting in elevated bladder pressure and the urgent need to urinate. Normal bladder function is restored when the bladder can relax and fill at low pressure to reasonable volumes before voluntarily contracting and emptying completely. Unexpected bladder emptying, or leakage, is defined as urinary incontinence. Of the several types of urinary incontinence, stress, urge, and mixed incontinence account for more than 90% of the cases.
Stress
Urine loss during physical activity that increases abdominal pressure (coughing, sneezing, laughing).
Urge
Urine loss with the sudden need to void, caused by an involuntary bladder contraction (also called detrusor instability).
Mixed
Both stress & urge components contribute to urine loss.
Post-Prostatectomy Urinary Incontinence
Post-prostatectomy urinary incontinence (PPI) is the term used to identify the involuntary leakage of urine following radical prostatectomy to treat prostate cancer. Specifically, PPI represents a specific form of stress urinary incontinence, where increased abdominal pressure from a cough, sneeze, or simple physical straining results in the leakage of urine per urethra. Under normal conditions, this increase in abdominal pressure is managed uneventfully by contraction of the external urinary sphincter (EUS), the muscle surrounding the early part of the male urethra, preventing loss of urinary control. During PPI, this sphincter mechanism is insufficient in maintaining closure of the urethra, permitting urinary leakage.
Between 5-10% of patients undergoing radical retropubic prostatectomy for prostate cancer will suffer clinically significant PPI manageable only with additional therapy. As many as 30% of patients undergoing this procedure will notice some degree of urinary incontinence following surgery. The majority of these patients will, however, regain urinary control within the first post-operative year and require no additional therapy. If after 9-12 months the patient is dissatisfied with his level of urinary control, a discussion of the artificial urinary sphincter (AUS) is appropriate. The AUS-800 from American Medical Systems represents the most effective cure for PPI. Over 90% of patients report satisfactory urinary control following implantation and a similar percentage of patients report that they would both undergo the procedure again and would recommend implantation to a friend suffering similar difficulties. The AMS-800 can be implanted in under 1 hour through a single small incision in the scrotum which heals with an almost imperceptible scar. There are no externalized components and to the casual observer, as in a public shower or restroom facility, it is completely unnoticeable.
Medical (Pharamcologic) Treatments
Minimally – Invasive Approaches
- Bladder botox injection for severe urgency/urge incontinence
Intravesical (bladder instillation) agents for interstitial cystitis treatment
Interstim neuromodulation (sacral nerve stimulation)
Injectable Bulking Agents
Surgical Treatments
- Advance bulbar urethral male sling (http://www.amsadvance.com)
- Artificial urinary sphincter (AMS-800) (post-prostatectomy male incontinence)
Artificial Urinary Sphincter
- Solyx mid-urethral sling for urinary incontinence (female).
Solyx SIS System
Click here for more information. - Bio-Arc trans-obturator sling (female)
- Bone-anchored bladder neck sling (female)
- Simultaneous cystocele-sling repair for stress incontinence associated with vaginal prolapse (CAPS procedure)
