Dr. Samuel Lawindy Talks About How to Treat Urge Incontinence in Women

KEY TAKEAWAYS:

  • Urge incontinence is a condition characterized by a strong, sudden uncontrollable urge to pass urine, which often results in urine leakage. It is often caused by dysfunction of the bladder or pelvic floor muscles due to factors such as pregnancy, childbirth, and hormonal changes around menopause.
  • The treatment for urge incontinence often involves a combination of medications, such as anticholinergics and beta adrenergics, and behavioral treatments like bladder training, pelvic muscle exercises, biofeedback, or urge suppression. If medications don’t work, minimally invasive procedures may be recommended.
  • At Advanced Urology Institute, prompt, reliable, and effective treatment is provided to patients suffering from urge incontinence, emphasizing that it is a treatable medical problem and should not be accepted as a normal part of aging.

At Advanced Urology Institute we see an increasingly high number of women presenting with urge incontinence. Urge incontinence is a condition where you are unable or have difficulty holding urine in your bladder long enough to reach the bathroom.  And so, it is characterized by a strong, sudden uncontrollable urge to pass urine, which often results in urine leakage.

What are the signs that a woman has urge incontinence?

  1. Urine leaks associated with a sudden compelling desire to pass urine
  2. Strong urge to urinate frequently
  3. Changing multiple incontinence pads through the day
  4. Awkward leaks of urine that cause embarrassment
  5. Organizing life and activities around bathroom locations when in new environment

What causes urge incontinence?

Even though up to 50-percent of women may have urge incontinence at some point in their lifetime, roughly 10-20 percent experience extremely bothersome urge-related urine leakage. 

Incontinence may occur as a separate condition, but in some women, it presents alongside other forms of incontinence due to an underlying medical condition. 

Urge incontinence is often caused by dysfunction of the bladder or pelvic floor muscles. 

Generally the dysfunction is due to:

  1. Pregnancy
  2. Childbirth
  3. Hormonal changes just before or after menopause

How is urge incontinence treated?

If you have persistent urge-related urine leaks, consider seeking a board certified urologist for a prompt diagnosis.  During your visit, the doctor will take your medical history and conduct a complete physical examination focused on your urinary system, reproductive organs and nervous system. The doctor will also order various tests which will likely include an analysis of your urine sample.

If urge incontinence is diagnosed, your doctor will prescribe medications to relax your bladder and pelvic muscles as a way of relieving the symptoms. The medications may be used alone or in combination with behavioral treatments, such as bladder training, pelvic muscle exercises, biofeedback, or urge suppression.

The two major classes of medications used for urge incontinence are: anticholinergics and beta adrenergics.  

The anticholinergic drugs include:

  • Darifenacin (Enablex)
  • Fesoterodine (Toviaz)
  • Oxybutynin (Ditropan, Oxytrol, Gelnique)
  • Solifenacin (VESIcare),
  • Tolterodine (Detrol),
  • Trospium (Sanctura). 

The beta adrenergic medications include:

  • Mirabegron (Myrbetriq)
  • Vibegron (Gemtesa)

Your doctor may also recommend vaginal estrogen (creams, pellets or rings) as a form of estrogen replacement therapy to help you if the incontinence is due to menopause, particularly if the incontinence occurs alongside vaginal atrophy (dryness).

If medications don’t work, your urologist may consider minimally invasive procedures. A procedure such as percutaneous tibial nerve stimulation, electrical stimulation, sacral neuro-modulation therapy (Interstim), or Botox bladder injection may be recommended.

Prompt, reliable and effective treatment

At Advanced Urology Institute, we encourage patients to believe that urine leakage does not have to be a normal part of aging.  Incontinence is a medical problem that can be treated effectively to reduce symptoms or eliminate the problem completely.  So we strongly insist that no woman should tolerate or endure this kind of discomfort, especially when it is bothersome and is affecting their quality of life.

If you’re struggling with embarrassing urine leakage, please get in touch with us to schedule your consultation and find out how we can help you. At AUI, we offer some of the latest and best interventions in treating urological disorders.  For more information on the diagnosis and treatment of urinary incontinence and other urologic disorders, visit the site “Advanced Urology Institute.”

TRANSCRIPTION:

So my name is Samuel Lawindy.
I’m a board certified urologist at Advanced Urology Institute.
So there is urgency and urgent incontinence for women.
That occurs when someone feels that they have the desire to go to the bathroom and they
can’t quite make it in time and then they’ll be leaking urine before they get there, wearing
multiple pads throughout the day, always aware of where the bathroom is and that commercial
everyone knows about got to go, go, go to the bathroom.
That’s urgent incontinence.
Very easily treated with medications and multiple different medications can be utilized.
If that doesn’t work, then there is some minimally invasive surgical procedures that can help you.

REFERENCES:

Can Dr. Samuel Lawindy provide treatment for large kidney stones?

KEY TAKEAWAYS:

  • Percutaneous nephrolithotomy or nephrolithotripsy (PCNL) is a specialized procedure designed to remove larger kidney stones (2 cm or bigger) or complex stones, where minimally invasive procedures such as ureteroscopy and shock wave lithotripsy are not effective.
  • PCNL is performed under general anesthesia with a tiny incision made in the back of the kidney, using ultrasound or fluoroscopy guidance, and involves breaking the stone into smaller fragments with a laser or ultrasound, which are then safely flushed out of the kidney.
  • While PCNL carries some risks, such as injury to nearby organs, infection, and bleeding, it is generally a safe and effective minimally invasive procedure that provides immediate relief from symptoms and fast recovery times.

 A kidney stone that is 2 cm or larger in size causes more severe symptoms. Unfortunately, for such a large stone, the usual minimally invasive procedures such as ureteroscopy and shock wave lithotripsy do not work.

So you’ll need a more specialized procedure called percutaneous nephrolithotomy or nephrolithotripsy (PNCL).

PCNL is a surgical technique designed to remove kidney stones located in the kidney or upper ureter, where shock wave lithotripsy or ureteroscopy are not effective. Also, it is the ideal procedure for stones that are too large.

How is PCNL performed?

With percutaneous nephrolithotomy or nephrolithotripsy, a tiny incision is made through the back of the kidney directly to where the stone is.  To gain access to the exact location of the stone in the kidney or upper ureter, the surgeon relies on the guidance of ultrasound or fluoroscopy.

Once the stone is reached, the surgeon uses a power source, such as laser or ultrasound, to break the stone into smaller fragments. The resulting smaller pieces are safely flushed out of the kidney through an external tube or an internal stent.

Typically, your surgeon passes a nephroscope—a miniature fiber-optic camera—together with other small instruments through the incision and into the kidney area where the stone is located. These instruments allow the surgeon to see the stone and to then use high frequency sound waves to break it.

If the resulting pieces of the stone are removed via the tube, the procedure is called percutaneous nephrolithotomy (PCNL). But if the stone is broken up and removed by other means, the procedure is called percutaneous nephrolithotripsy (PCNL).

Depending on the position of the stone in the kidney, the surgeon will take 20 to 45 minutes to complete the procedure. The goal of the procedure is to remove all of the stone, so that no pieces are left to pass through your urinary tract.

When is PCNL recommended?

Percutaneous nephrolithotripsy or nephrolithotomy is used for:

  1. Larger stones, 2 cm in diameter or bigger
  2. Complex stones
  3. Lower pole renal stones, larger than 1 cm
  4. Irregularly shaped stones
  5. Removing kidney stones in people with infections
  6. Stones that have not broken up enough by SWL (extracorporeal shock wave lithotripsy)
  7. Kidney stones in individuals who are not candidates for ureteroscopy

Is the procedure safe?

Percutaneous nephrolithotomy does have risks but is generally a safe, effective minimally invasive procedure. Most often, it successfully removes larger kidney stones and results in immediate relief of symptoms.

During PCNL, a hole is created in the kidney that should eventually heal without other forms of treatment. However, since the procedure is done around the back or abdomen, it comes with a small risk of injury to other nearby organs, like the ureter, bladder, liver, or bowel. 

Also, like other surgical operations, PCNL comes with some risk of infection and bleeding. And because all surgeries on the kidney have a relatively rare long-term risk of high blood pressure or reduced kidney function later in life, the procedure carries these risks and should be conducted by an experienced, specially trained urologist.

What is the recovery like after PCNL?

Percutaneous nephrolithotomy is done under general anesthesia. So after the procedure, you will need a short stay in hospital to be monitored before you can go home. 

Often, an overnight stay in the hospital after the surgery is enough and you can go home the very next day. Recovery is fast and generally smooth. You should be off work for just a week. 

Safe, successful PCNL

At Advanced Urology Institute, we consider percutaneous nephrolithotomy one of the most effective techniques for stones larger than 2 cm in diameter. From our experience, patients leave the hospital stone-free after the procedure and are usually completely freed from any stone-related symptoms.

At Advanced Urologist Institute, we have a talented and skilled pool of urologists that perform the procedure frequently. For more information on the diagnosis and treatment of kidney stones, visit the site “Advanced Urology Institute.”

TRANSCRIPTION:

So my name is Samuel Lawindy, I’m a board certified urologist at Advanced Urology Institute.

So if you have a large stone in the kidney, usually two centimeters or larger, minimally invasive procedures such as a ureteroscopy or shockwave will not work.

So a PCNL or long term is percutaneous nephrolithotripsy would work very well for that.

That is where the procedure goes through the back of the kidney, directly to where the stone is and we can break it up and pull those pieces out safely and it’s a one night overnight stay at the hospital and you go home the very next day and usually patients tolerate it very well.

It’s a good option for patients who have that stone, it’s important to recognize that it is done here and does not require a tertiary care center, we do take care of it here at this facility.

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My name is Rishi Modh, I’m a board certified urologist with Advanced Urology Institute. 

So quality of life after prostate cancer can be a big problem for guys. We do a great job of treating the cancer but sometimes we’re left with side effects. Those side effects often include urinary incontinence for guys or erectile dysfunction. Thankfully now we have great solutions for those problems too. One of the best options we have for guys is penile implants. A penile implant is a device that is an hour long surgery with a small incision done as an outpatient where you go home the same day. This provides lasting great erectile function for men, it really restores your quality of life.