Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise.
Wake Forest Baptist Approach
Stress and urge incontinence are often experienced together and Wake Forest Baptist urologists conduct a thorough evaluation to determine the presence and severity of both. A voiding diary is recorded to determine the number and frequency of urine loss and voiding habits. In addition, urodynamics may be performed to help guide the diagnosis and whether surgery is appropriate or not.
Pure urge incontinence, or overactive bladder, is treated medically and not by surgery. When medications aren’t successful, injections of botulinum toxin, or Botox®, is an option. The treatment has been shown to be effective in approximately 70 percent of cases, according to Gopal Badlani, M.D., co-director of the Continence Center. In an outpatient procedure, Botox injections are delivered through a small scope that is inserted into the urethra, the canal leading to the bladder.
For severe cases of overactive bladder that aren’t helped with other therapies, Wake Forest Baptist is part of a national study to evaluate laboratory-engineered bladders. The technology, developed by Anthony Atala, M.D., chairman of the Department of Urology, has already been successfully used in children with spina bifida and dysfunctional bladders.
In cases of combined stress and urge incontinence, treatment can include placement of mesh tape to support the tube leading from the bladder and keep it closed during stressful movements. Our practice has many years of experience with mesh slings for stress urinary incontinence. Our five-year results (Journal of Urology 2003; 170:849) show high sustained success rates over the long term (81% completely dry at 5 years) without any mesh infections.
Close to 1 million procedures have been done worldwide. Operative time is usually 30 minutes or less. Reported complications are low, and time to return to daily activities is relative short.
Other treatment options include a pacemaker for the bladder that can be used when more conservative treatments, such as medications or behavioral modification, are not effective. The device, which is implanted during an outpatient procedure, is used to treat three major types of urinary incontinence: urge, urgency-frequency and urinary retention, said John Smith, M.D., co-director of the Continence Center.
The device emits short, painless bursts of electrical current to stimulate the sacral serves, which influence the bladder. In some patients, the stimulation has been shown to eliminate or reduce bladder control systems.