Urinary Incontinence

Urogynecology

Urinary incontinence refers to the involuntary leakage of urine during physical activity, which may also be preceded by a strong urge to urinate. It is a common condition, affecting about 35% of women over 30 years old, with the frequency increasing with age.

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In stress urinary incontinence (SUI), urine leaks during coughing, sneezing, running, jumping, and lifting. One in three incontinent women also experiences leakage during sexual intercourse.

The most common cause of stress urinary incontinence is vaginal childbirth, while other factors include heavy physical work, obesity, and certain chronic diseases (e.g., COPD). All these issues put significant strain on the pelvic floor.

The cause of stress urinary incontinence can also be rooted in genetics, which determines the quality of connective tissue.

MINISLING OPERATIONS

The most effective method for treating stress urinary incontinence is sling operations.

At BUT Clinic, we implant the sling (minisling) in the least invasive way. The procedures are performed under local anesthesia with the patient in the gynecological position on the operating table. We make an approximately 1 cm incision just behind the vaginal entrance, under the urethra, and through this opening, we place the sling that supports the urethra and thus prevents urine leakage.

Patients go home immediately after their first spontaneous urination, which usually occurs within half an hour after the operation.

We recommend patients take up to 5 days of sick leave after the procedure if needed, otherwise they can return to work the day after the operation. The success rate of the operation, if there are no associated bladder or spine issues, is over 90% after 10 years.

URETHRAL BULKING AGENTS

The procedure is performed under local anesthesia using a urethroscope, an optical device with a cold light source, which allows us to examine the inside of the urethra.

During the procedure, we inject hydrogel or hyaluronic acid into 4 sites in the upper part of the urethra, near the bladder entrance, which causes the mucosa to swell and thus reduces the risk of urine leakage.

The success of this procedure is significantly lower than the minisling operation, as even in the most experienced hands it does not exceed 60%, which is why the procedure needs to be repeated.

LASER THERAPY

The effectiveness of laser in urogynecology is not well researched and has not been proven, except in biased studies. The laser energy simply does not penetrate deep enough into the vaginal tissue under the urethra to induce a therapeutic effect.

Any potential “success” of the laser is mostly short-term (a few months) and only in very mild forms of stress urinary incontinence, which often represents a placebo effect rather than success. At BUT Clinic, we do not recommend vaginal laser therapy for the treatment of stress urinary incontinence!

PRP and Stem Cells

Similar to laser therapy, we do not recommend the use of platelet-rich plasma (PRP) and stem cell injections for treating urinary incontinence.

While it may sound attractive and have a modern appeal, unfortunately, there isn’t much more in terms of effect. International urogynecological and urological organizations do not support the use of plasma, stem cells, and laser therapy!

OAB is a disorder that can be diagnosed in one in six people over the age of 40. The main symptom of the disorder is urgency, which means a sudden and strong desire to urinate without prior warning.

Urgency forces a person to abandon all activities they are engaged in and go to the bathroom immediately. In this case, one in three women may leak urine before reaching the toilet. This is referred to as urge urinary incontinence.

The disorder (OAB) is often accompanied by a feeling of frequent urination during the day (frequency) and nighttime urination (nocturia).

The frequency of the disorder increases with age, and the symptoms progress over the years in both variety and intensity.

Lifestyle Adjustment
Bladder Training
Urination Diary
Medication Treatment
Physiotherapy (magnetic chair stimulations, tibial nerve stimulation, etc.)

Mixed urinary incontinence is a combination of symptoms of stress urinary incontinence and overactive bladder symptoms. The treatment method is usually determined by the most bothersome symptom of the disorder.

Bladder Training: The first approach to treatment is bladder training, where urination is scheduled at specific time intervals. Initially, urination is done every hour and a half, and once this rhythm is established, the interval between urinations is extended by 15 minutes weekly until urination occurs every three hours, provided that at least 1.5 liters of fluid is consumed daily (25 ml/kg body weight). The normal amount of urine after three hours of retention should be between 250 and 300 mL.

Lifestyle Adjustment: Adapting one’s lifestyle plays a significant role in reducing the problems caused by OAB. We recommend quitting smoking, as nicotine directly causes bladder contractions. We also advise avoiding excessive consumption of coffee and carbonated drinks. Coffee has a direct stimulating effect on the smooth muscle walls of the bladder. For individuals who are overweight, we recommend losing at least 7-10% of their body weight, as this measure alone will halve bladder problems. Chronic constipation can also be an issue, so we advise a dietary regimen, drinking Donat water, and using natural preparations (probiotics) that ensure balanced digestion.

Urination Diary: A simple tool for monitoring fluid intake and urination is a urination diary, where you record the amount and type of fluid consumed, the volume and time of urination, the time when urine leaks, and the provocation that led to it. Usually, the urination diary is filled out for 3 consecutive days and then handed over to the personal physician at the clinic.

Medications are effective, but their success depends on expectations and potential burdensome side effects. Medications provide improvement in condition, but not complete dryness. The available medications allow, on one hand, the bladder muscles to relax, enabling the bladder to hold more urine, and on the other hand, they prevent or reduce bladder muscle contractions, which can improve urine leakage that follows strong pressure (urgency). The effect of the medications is to reduce bladder wall tension, leading to improvement in symptoms. In addition to these medications, antidepressants can also help as they calm the bladder as well.

This is a diagnostic examination performed to assess the function of the lower urinary tract (urethra and bladder).

Urodynamic studies comprise a set of procedures that evaluate the storage and voiding phases of urination. The most important examinations are cystometry and pressure-flow measurement.

Cystometry assesses bladder function during filling, while pressure-flow measurement evaluates the coordination of the bladder and urethra during bladder emptying (urination).

The examination is important in diagnosing unclear causes of urinary incontinence, potential failure of surgical treatment for urinary incontinence, and in assessing causes of inability to urinate.