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Incision-Free Treatment Could Control Leaky Bladders

Procedure Helps Firm Up Tissue

POSTED: 7:06 pm MDT September 3, 2009
UPDATED: 1:52 pm MDT September 4, 2009

Pregnancy, childbirth and menopause leave women more prone to bladder problems. But an incision-free procedure is giving people back their confidence.

Barbara Calvert has struggled with bladder control problems since her 20s.

"To me that was just a normal part of having had two children," Calvert said.

It stopped being normal when her incontinence made her feel like a prisoner in her own home. For years, she resisted surgery.

"I decided against that because of the pain and the downtime. Losing anywhere from two to six weeks of work, not being able to pick up the grandchildren ...," Calvert said.

Traditional surgeries are done in the operating room and leave behind sutures and pieces of mesh or other material.

"They are foreign objects and some people don't tolerate foreign objects and they can be rejected," said Dr. David Jacobs, a urologist with West Florida Urology in Tampa, Fla.

In a new surgery, doctors use radio frequency to tighten muscles around the bladder -- no incisions required.

"Under local anesthesia, done in the office, it generally takes approximately 15-20 minutes," Jacobs said.

Patients see results in two to four months. It's the solution Calvert had waited for.

"I finished the procedure, came and sat at my desk at the office, started answering phones," Calvert said. "It's changed my whole life completely."

Jacobs said he has seen a success rate of 70 percent with the less-invasive procedure, which he said includes both improvements and complete cures. To qualify for the procedure, a woman must suffer from a condition called stress incontinence, triggered by activities like running and coughing.

Addition Information About Procedure

BACKGROUND:

In 2006, nearly 400,000 women in the United States underwent a surgical procedure to correct stress urinary incontinence (SUI), and experts expect that number to grow over the next several years.

SUI is a condition that that causes involuntary leakage of urine during activities like laughing, coughing, sneezing and exercise or recreational activities.

One of the biggest risk factors for the condition is childbirth. This is because childbirth sometimes causes nerve damage to the pelvic floor muscles. SUI resulting from this damage may begin soon after delivery or years later.

According to the Mayo Clinic, other risk factors for the condition include aging, menopause, obesity and previous pelvic surgery like a hysterectomy.

TREATMENTS:

To treat stress urinary incontinence, doctors usually recommend behavior therapies first. Depending on the circumstances, these can include weight loss, smoking cessation, increased water intake and pelvic floor exercises called Kegels.

Anticholigernics, or medicines that help relax bladder muscles, help some women with SUI. Side effects of the drugs include dry mouth, blurred vision, constipation, rapid heartbeat and flushing. Devices like a vaginal pessary -- a ring-shaped device that helps support the bladder -- offer relief to other women.

When behavior changes don't work, some women opt for surgery. Surgical options used in the treatment of SUI include suspension and sling procedures.

In suspension, surgeons use surgical threads to help support the bladder neck. In the most common type of the procedure, an incision is made in the abdomen a few inches below the navel. Through that incision, the surgeon secures threads to strong ligaments within the pelvis.

In sling procedures, surgeons place synthetic mesh materials midway along the urethra. They place the materials through several small incisions. Suspension and sling procedures are performed under either spinal/epidural anesthesia or general anesthesia.

Recent research performed by the Urinary Incontinence Treatment Network found two years after suspension or sling procedures, about two-thirds of women with a sling and about half of those with a suspension were cured of SUI (Source: National Institute of Diabetes & Digestive & Kidney Disease). Overall, 86 percent of women with a sling and 78 percent of women with a suspension said they were satisfied with the surgery results.

A SURGERY-FREE OPTION:

During a new treatment called the Renessa System, doctors use a small probe to pass through the natural opening of the urethra while the patient is under local anesthesia. The probe is then used to heat several small sites at the bladder neck and upper urethra. The treatments cause the collagen in the tissue to "reorganize." When the sites heal, the tissue is firmer and more resistant to leakage.

Doctors hope to use the Renessa procedure in the future to improve results after non-successful surgeries for SUI. Experts estimate that over the next five years, about 700,000 women will experience sub-optimal results after such surgeries.

Additional Information:
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