Mesh Medical Device News Desk ~ By Dr. Una Lee, MD, Virginia Mason Hospital and Medical Center, Bellevue, Washington State
Image: Dr. Una Lee, MD, urology, Virginia Mason
It is important for all women to be educated on how their urinary tract works and options that exist when problems occur. A mid-urethral mesh sling is a common surgery that treats stress urinary incontinence. It has been one of the standard surgical treatments for stress incontinence since 1997. The synthetic mesh sling works by acting as a “hammock” under the urethra, helping to keep it closed with activities like coughing or sneezing. However, women should be aware that there is an infrequent but known risk of minor, moderate or serious complications associated with mesh sling surgery. Many women ask if there are alternatives to mesh slings. Absolutely!
First, a quick review of incontinence basics. Urinary incontinence is the leakage of urine that can occur in women of all ages, and commonly occurs or worsens after childbirth. There are difference types of urinary incontinence, including:
- Stress incontinence – leakage with physical activity, like laughing or coughing
- Urgency incontinence – leakage that occurs when you have a strong urge to urinate and are rushing to the bathroom
- Mixed urinary incontinence – a common condition of having both stress and urgency incontinence
- Post-void dribbling – leakage after you urinate
- Incontinence without sensation – leakage that occurs with no awareness
The type of incontinence is important, because different treatments target different types. Also, the amount of leakage – mild, moderate or severe – will also affect treatment options.
Starting with the least complicated, conservative management may be appropriate if urinary leakage is mild, infrequent, not very bothersome and can be controlled with pads. For many women, no treatment is a valid choice.
Weight loss is another non-surgical opportunity. Studies have shown that modest amounts of weight loss (5 percent of total body weight) can significantly decrease urinary incontinence. For many women this is motivating and encouraging, while promoting their overall health.
Stopping smoking is another effective step. Smoking and the chronic cough associated with tobacco use can make urinary leakage worse. Abdominal pressure from frequent coughing will in turn increase pressure on the pelvic floor and urethra, causing leakage.
Pelvic floor physical therapy with a qualified physical therapist who specializes in urinary incontinence is a totally natural option. You learn how to identify and strengthen your pelvic floor muscles correctly and how to use this skill to prevent leakage. This therapy is known to be effective and is a skill you can use for life.
Incontinence pessaries are medical grade discs that are placed in the vagina to support the urethra. The size and shape is custom fitted to you, and it is removable and comfortable. It is a good non-surgical option to try.
Urethral bulking is an injection into the inner lining of the urethra, which improves the sealing abilities of the inner part of the urethra. While not generally permanent, it’s an effective treatment for the right patient.
The Burch procedure preceded sling surgery as a standard stress incontinence treatment. Instead of creating a hammock supporting the urethra, sutures are placed for support and elevation. While not as effective as the sling procedure, the Burch procedure remains an option for some patients.
A variation on the sling procedure known as the autologous fascial sling has been around for years and has stood the test of time. A strip of fascia, or connective tissue, is harvested from your thigh or lower abdomen, then placed to support the urethra. While this surgery is effective, durable and safe, the downside is that it’s more invasive and requires longer healing time.
Enrolling in a clinical trial may be an option for some patients. Eligible participants volunteer and are fully informed of the study’s process and potential risks and benefits. Participants are advised to talk to their health care provider before participating in a clinical trial. One study is currently investigating using muscle-derived, regenerative cells to treat stress urinary incontinence. For more information on participating in clinical trials, click here.
Vaginal laser treatments, using a carbon monoxide (Co2) laser, are used as a therapy for vaginal dryness and atrophy. Currently, there is not enough evidence to support the claims that they treat stress urinary incontinence. Additionally, laser treatments are costly and typically not covered by insurance.
Medications for urinary incontinence generally help with urgency incontinence and overactive bladder symptoms, but not stress urinary incontinence. So they can help with that “gotta go” feeling and resulting leakage, but not with leakage that happens during Zumba class. These medications are designed to help with bladder control. Most are prescription, so ask your doctor if bladder medications are appropriate for you. One treatment, the oxybutynin transdermal patch, is available over the counter. Side effects can occur with these medicines, with about 20 to 40 percent of women remaining on the medication in one year’s time.
Treatment with vaginal estrogen helps treat thinning tissues in the vaginal area. By improving the quality of the tissues, symptoms of urinary urgency can improve. Some women report their incontinence improves as well.
Botox injections in the bladder can dramatically help women who have leakage of urine that is associated with urgency, but are not effective for stress urinary incontinence.
Bladder pacemakers, also known as InterStim therapy, regulate bladder signals by stimulating the sacral nerves located near the tailbone. This electrical stimulation helps the brain and bladder communicate for better urinary control. The implants help reduce urinary urgency and resulting leakage, urinary frequency and urinary retention (the inability to empty the bladder).
Urinary incontinence is a common, costly and important quality of life issue for women. Gaining a thorough understanding of the condition is the first step. Given the sensitive nature of these bodily systems and their impact on women’s lives, knowing the range of treatment options is key to making the right choice for you.
Una Lee, MD is a urogynecologist/urologist dedicated to women’s health. Dr. Lee and her partners in the Urology Department at Virginia Mason offer all FDA-approved treatments for urinary incontinence, with the knowledge and experience to support the best outcomes.