On the initial evaluation, this will include your personal history, physical examination at which time a pelvic examination will be performed. Commonly we’ll perform this and we’ll attempt to evaluate for incontinence occurring. Also an assessment of post-void urinary residual is commonly done by a little bladder scan instrument. In some circumstances, we may have to perform an in-and-out catheterization through the urethra to drain the bladder and to check the urine and also assess for residual urine in the bladder.

After that evaluation, depending on your history, at times further evaluations may include cystoscopy, or further evaluation by a urodynamic assessment could be recommended,
but not routinely necessary for most patients with more straight forward stress urinary incontinence. Additional evaluations at times may be recommended if the specific cause or type of incontinence is unclear or uncertain, and if confirmed stress incontinence is not demonstrated on initial examination, or if the patient has other or mixed incontinence including urinary urgency which raises the question of a different cause of the incontinence being more prevalent or more common. Sometimes if patients have a high post-void residual, or amount left in their bladder, or prior surgical failures or even recurrent incontinence having previously been treated, further evaluation may be warranted.

But after the initial evaluation is completed and the patient’s coming to a definitive treatment plan, there are non-surgical treatments that can be addressed. A continence pessary, vaginal inserts for urinary incontinence, pelvic floor muscle therapy or Kegel exercises, BTL or Emsella therapy which is a non-invasive, electromagnetic stimulation of the pelvic floor musculature for the purposes of rehabilitation of weak pelvic floor muscles, restoration of neuromuscular control for the treatment of female and male urinary incontinence. Those are fairly simple and non-invasive treatments. Surgical treatments include bulking agents, mid-urethral sling which are either retropubic or transobturator in approach. Single incision slings are newer and may be used in select patients, but overall the efficacy and safety data are not as well-defined as the others. There are a number of potential benefits to use of mesh slings for incontinence, but there are also some risks associated with these.

Now I’m gonna list these risks and these are very commonly described and many of them may be inherent to other surgical treatments for stress incontinence procedures so don’t let this put you off but I think it’s important that you hear some of this. Some of the problems that occur with sling procedures, including mesh sling procedures are pain or discomfort, swelling caused by fluid retention, erythema or redness of the skin, infection, bleeding in the area, either vaginally or at the sling insertion site, scarring or mesh erosion which is the presence of mesh material within the organs surrounding the vaginal area, or mesh extrusion which is kind of the body rejecting the mesh, fistula formation would be extremely rare, which is an abnormal communication between two structures,foreign body responses which is a reaction to the mesh itself, urinary incontinence or involuntary leakage of urine or overactivity can occur with many sling procedures, not infrequently. Urinary retention, making the sling too tight. That’s inherent with any sling product but again very rare. Voiding discomfort or disfunction, difficulty with urinating can occur after a sling procedure or really any incontinence procedure. Vaginal discharge can occur, nerve damage or again bladder instability. Sometimes after you operate around the bladder, you may develop more urgency of urination for a period of time and sometimes this is prolonged. The sling can migrate which would be again extremely rare. Dyspareunia or pain with vaginal intercourse has been described with mesh sling procedures and other vaginal procedures. So the alternatives to mesh slings also include other slings using the patient’s own fascia, commonly termed it pubovaginal sling. We obtain the fascia from the suprapubic area or below the belly button or sometimes from the thigh. This does carry with it some added morbidity including pain, separate incisions to harvest the material. An alternative to this is a bladder neck suspension. The common one that’s a part of normal guideline criteria is called a Burch colposuspension. And that does not involve the use of mesh.

Now each of these treatments can be effective for your incontinence and the risks and benefits of each of these, along with your overall history and exam findings, will determine which surgical treatment you may end up selecting, along with your urologist or doctor.

At Northwoods Urology, we understand the importance of urologic health. Visit our website for more tips about urinary incontinence. If you suffer from any of these symptoms and would like a professional approach, contact our office for an appointment.