Female Urology and Urinary Incontinence
Although it is observed in early ages, almost 35% of women over 60 age are suffering stress urinary incontinence.
Urinary spihincter which is a valve- like muscle, controlling the release of urine is weaker in women than that of men because of female anatomy. As time passes, the urinary sphincter may loose strength because of pragnancy, childbirth (especially difficult ones), age and previous gynecologic surgery.
When the sphincter weakens more, anything that brings force on abdominal and pelvic muscles such as sneezing, coughing, lifting, laughing; can put pressure on the bladder and causes urine leakage. This situation is called Stress Urinary Incontinence (SUI).
What are the Symptoms?
Patients having stress incontinence may leak urine when they cough or sneeze, laugh, lift something heavy, walk rapidly. It may start with a few drops but increases to an amount that the patient needs to change sanitary pads many times a day.
What is the Medical Name of This Type Of Urinary Incontinence?
It is called “Stress Urinary Incontinence” in urology. It is the most common type among healthy women. It is not related with psychological stress.
How Does Stress Incontinence Occur?
Stress incontinence occurs when the muscles that support the urethra (pelvic floor muscle) and the muscles that control release of urine (urinary sphincter) loose strength due to the above mentioned reasons. As the urinary sphincter gets unbalanced and unstable, the mechanism preventing the urine leakage weakens. This results in stress urinary incontinence.
How to Diagnose?
Getting the medical history of the patient in detail, testing urine sample and gynecological examination by a experienced urologist are the important ways to determine sui.
How to Treat (Sling/Hammock Procedure)?
This treatment is a surgery which is known as Trans Obturator Tape (TOT). The aim of this surgical intervention is to improve the closure of the urinary sphincter or to support the bladder neck. “Hammock ” procedure is the most commonly performed in women suffering stress urinary incontinence. The surgeon uses strips of synthetic mesh or patient’s own tissue or animal or a donar tissue to create a sling or “hammock”. The hammock is located under the weakend and unstable urethra. The hammock supports the urethra and keeps it closed. Then the patient does not leak urine while coughing or sneezing etc..
Is Anaesthesia Required For This Surgery? How is Post Operation Period?
This surgery is performed under general or local anaesthesia. Although some surgeons allow patients to check out in 3 or 4 hours after surgery, we prefer overnight stay due to our experiences. After 24 hours of the surgery we remove the probe (we inserted in the urethra during the surgery) and then let the patient check out.
The success rate of this surgery is very high. 98% of our patients do not have stress incontinence anymore in short and long term. Since the surgery is performed inside the vagina there is no incision and no pain after surgery.
What is the Consequences of Unsuccessfull Surgery?
Patients may have some problems after this surgery. The most important one is urinary retention which is the inability to urinate. İn such a case an other surgery is needed to remove the hammock. Another risk of the surgery is urge incontinence which can be followed by an involuntary loss of urine.
Occurence of Urgency İncontinence After Tot Surgery:
If the surgeon did not examine the patient well enough and did not diagnose the urge incontinence (sudden intense urge to urinate) or if the pressure of the hammock is not set well, urgency incontinence may happen after the surgery.
The importance of the experience of the surgeon:
An extensively experienced surgeon can easily evaluate if the patient is suffering stress urinary incontinence (by laughing, coughing or sneezing) or it is accompanied by urge incontinence (intense urge to urinate and leakage of urine) and plans the surgery accordingly.
Although tot seems to be a simple surgery, the gynecological exam before the surgery is very important to determine the pressure of the hammock to be implanted under the urethra. If this examination before surgery is done there will be no problem afterwards.