Addressing Incontinence in Women – Insights by Quynh-Dao Tonnu, PA-C

Key Takeaways:

  1. Incontinence in women can have different causes and diagnosis and requires tailored treatment options.
  2. Breaking the stigma and silence around incontinence is essential to encourage women to seek help.
  3. Advanced Urology Institute in Orange City, FL offers top-tier medical support and personalized treatment options to help women regain control over their lives.

Quynh-Dao Tonnu, a leading physician assistant at Advanced Urology Institute, offers expert insights into a topic that is often whispered about, but seldom openly discussed — female incontinence. Hidden behind hushed tones and uneasy glances, incontinence in women is a common but rarely explored issue.

Overactive Bladder and Female Incontinence

Tonnu attributes female incontinence to two common reasons. The first could be a narrowed urethra, which might require medical procedures or dilation. The second possibility is an overactive bladder where, as Tonnu explains, “The bladder contracts inappropriately, making them go more frequently.”

What’s important to note here is that both situations can have profoundly different approaches for diagnosis and treatment. Incontinence, and especially overactive bladders, can disrupt the rhythm of life, making it essential to “assess the underlying cause.”

Breaking the Silence

For many women, speaking about their incontinence can feel invasive and embarrassing. However, Tonnu’s empathetic and understanding approach encourages open conversations about this condition. As a physician assistant, and more importantly, a woman herself, Tonnu establishes a comforting sense of intimacy that encourages patients to share their experiences.

“I personally don’t find it particularly difficult to have that conversation with patients,” says Tonnu. “Perhaps because I’m female there’s already a sense of intimacy that they can share with me.”

Recognizing the Need for Help

Undoubtedly, opening up about incontinence is a bold step, signifying the point where the condition has become bothersome enough for the individual to seek help. Tonnu remarks, “Once they’ve consciously made the decision to make an appointment and come in, they’re usually willing to talk about it.”

This willingness to seek help and discuss their issues is a testament to the motivational environment created by Tonnu and her colleagues at Advanced Urology Institute. When a woman is ready to address her concerns, it means that she has acknowledged the problem and is prepared to take the necessary steps towards her treatment.

Choosing the Right Support in Orange City, FL

Tonnu’s dedicated approach to handling female incontinence provides hope for many women silently coping with the condition. By encouraging open conversations and providing personalized treatment options, she helps these women regain control over their lives. Located in Orange City, FL, Tonnu and the team at Advanced Urology Institute offer top-tier medical support to anyone facing urological concerns.

As the largest urology practice in Florida, the Advanced Urology Institute stands at the forefront of urinary health issues like overactive bladder and female incontinence. Their team of experts, led by individuals like Quynh-Dao Tonnu, PA-C, work tirelessly to ensure that each patient receives the best possible care. Because at the end of the day, it’s not just about treating a condition – it’s about reclaiming your life from the shadows of incontinence.


  1. Bladder Problems | Advanced Urology Institute. (2023, September 19). Advanced Urology Institute.
  2. Advanced Urology Institute. (2023, May 19). What is Urinary Incontinence in Women and how can Dr. Amar Raval help? | Advanced Urology Institute. Advanced Urology Institute. \
  3. Advanced Urology Institute. (2023, April 24). How does Dr. Rishi Modh treat female urinary incontinence? | Advanced Urology Institute. Advanced Urology Institute.
  4. Hartmann, K. E., McPheeters, M. L., Biller, D. H., Ward, R. M., McKoy, J. N., Jerome, R. N., Micucci, S. R., Meints, L., Fisher, J. A., Scott, T. A., Slaughter, J. C., & Blume, J. D. (2009). Treatment of overactive bladder in women. Evidence Report/Technology Assessment, 187, 1–120, v.
  5. NHS Choices. (2023). Overview – Urinary incontinence.
  6. Elad Leron, Weintraub, A. Y., Salvatore Andrea Mastrolia, & Schwarzman, P. (2018). Overactive Bladder Syndrome: Evaluation and Management. Current Urology, 11(3), 117–125.
  7. Urinary incontinence | Office on Women’s Health. (2014).


My name is Quynh-Dao Tonnu, I’m a physician assistant at Advanced Urology. So it could be two things, they could have like a narrowed urethra or maybe they need to be dilated or have a procedure or it could be they have overactive bladder and they’re bladders kind of contracting inappropriately and making them go more frequently so we kind of have to assess the underlying cause. I personally don’t find it particularly difficult to have that conversation because maybe because I’m female and so there’s also there’s already like a sense of intimacy that they can share with me but also if once they’ve consciously made decision to make an appointment and come in then they’re usually willing to talk about it because it’s gotten to that point where it’s bothersome to them.

Natural remedies for an overactive bladder

An overactive bladder (OAB) is a condition where you are not able to hold urine in your bladder due to involuntary bladder muscle contractions.  It causes a frequent, sudden and difficult-to-control urge to pass urine, which may lead to unintentional loss of urine. You may also feel the urge to pass urine 8 or more times in 24 hours.

With an overactive bladder, the first-line treatment is usually behavioral and lifestyle changes. But if the condition remains troublesome even with the changes, further treatment may include medications, bladder injections, nerve stimulation, percutaneous tibial nerve stimulation (PTNS), or surgery. 

So what are the natural remedies for an overactive bladder?

  1. Eliminating bladder irritants

Symptoms of an overactive bladder can be relieved by avoiding foods and drinks known to irritate the bladder. 

Common culprits include alcohol, caffeine, artificial sweeteners, citrus fruits and juices, and chocolate. Other foods and drinks to avoid or reduce are sodas and fizzy drinks, cranberry juice, corn syrup, tomatoes, sugar, honey, vinegar, dairy, and spicy foods.

Since irritation from foods and drinks vary from person to person, you can benefit by keeping a diary of what you take and the associated bladder symptoms. A diary can help you work out which foods are causing you problems.

  1. Making lifestyle changes 

Quitting smoking can remedy an overactive bladder. That’s because smoking tends to make the symptoms of the condition worse, while the coughing fits associated with smoking tend to increase OAB-associated leakage of urine

Another change that can improve an overactive bladder is withdrawal of medications contributing to the problem. For instance, diuretics, antihistamines, muscle relaxants, sedatives, narcotics, and alpha-adrenergic antagonists worsen OAB symptoms. So if you’re taking any medications you suspect to be behind the problem, speak with your doctor about alternatives. 

Also, losing weight can reduce the pressure on your bladder and pelvic floor muscles, and improve your bladder control.

  1. Using bladder control techniques

There are a number of bladder control techniques you can apply, including scheduled urination, delayed urination, and double-void technique. 

    • Scheduled urination

By scheduled urination, you keep a diary of your urinary habits, such as bathroom visits, any leakages, and urgency symptoms. Based on the patterns in your diary, you start scheduled bathroom trips aimed at adding at least 15 minutes to your normal urination times. 

For example, if you pass urine every 60 minutes, you change this and schedule your bathroom breaks for every 75 minutes. Then you stick to these scheduled visits regardless of whether you feel the urge to pass urine or not. After that, you gradually increase the time interval between your bathroom visits 

    • Delayed urination

Delayed urination means every time you feel the urge to go, you try to delay by some minutes, if possible, usually by at least 5 minutes. You can use relaxation techniques, such as deep breathing to help delay. The aim is to gradually increase the delay time until you have achieved a 3-4 hour gap between your bathroom visits.

    • Double voiding

Double voiding technique is useful if you feel your bladder does not empty fully. It is also worthwhile to double void before bedtime. 

To do so, you sit in the toilet, lean slightly forward, rest your hands on your knees or thighs, and urinate as normal. Then you remain in the toilet and wait for another 30 seconds, leaning slightly further forward to urinate once more.

  1. Doing kegel exercises

Kegels involve strengthening exercises on the pelvic floor muscles, which are the muscles that help to control urine flow. To locate your pelvic floor muscles, try to stop urine flow midstream. If you succeed, it means you have located the muscles.

Now, practice squeezing these muscles for 10 seconds and relaxing for 3 seconds, repeating the pattern 10 times. Then try to do 3 sets of 10 repetitions daily. Deep breathe to make the process easier.

  1. Managing your fluid intake

Drinking plenty of water is essential for your health, and you shouldn’t stop because of an overactive bladder. 

That’s because taking too little water allows your urine to be more concentrated, which may irritate your bladder lining and increase urgency. But excess fluid intake may also make frequency symptoms worse, such as fluid intake before bed contributing to urinating during the night.  

Make sure to drink 6-8 glasses of water daily, but to avoid liquid intake 2-3 hours before going to bed.

  1. Using herbs and supplements

There are a number of herbs and supplements that are effective in treating an overactive bladder. Speak with your urologist about these options for recommendations, but don’t use them without your doctor’s advice. 

Effective herbs and supplements include:

  1. Gosha-jinki-gan

This is a blend of 10 traditional herbs that help with overactive bladder by increasing the bladder’s capacity and lowering bladder contractions. It reduces frequency, urgency, and nighttime urination in people with the condition. 

  1. Capsaicin

Capsaicin is an extract from chili peppers. It works by blocking signals from the nerves in the bladder and ensures the bladder holds urine longer. Plus, it helps to manage pelvic pain syndrome, of which overactive bladder is usually a symptom.

  1. Pumpkin seed extract

The extract is effective in improving pelvic floor health. It helps to strengthen pelvic floor muscles and enhances control of muscles involved in passing urine.

  1. Magnesium hydroxide

Magnesium helps maintain normal blood pressure, reduces muscles spasms, and allows the bladder to empty fully. As an alternative to magnesium hydroxide, you can add magnesium rich foods, like bananas, kale, pumpkin seeds, and cashews to your diet if your doctor deems it safe.

  1. Saw palmetto

Saw palmetto has been tested in men with an enlarged prostate, where it has demonstrated efficacy in treating the condition as well as relieving bladder control symptoms. Hence, using it helps improve bladder issues associated with OAB.

  1. Resiniferatoxin

This is a chemical derived from a cactus-like plant. It is effective in blocking signals from the bladder nerves to the brain; hence, reducing the strength of the urge to pass urine, allows the bladder to hold urine longer, and relieves symptoms of an overactive bladder.

  1. Vitamin D

Increased intake of vitamin D lowers the risk of pelvic floor disorders, such as bladder leakage, especially in women. For older adults, more vitamin D in the diet or as a supplement effectively prevents bladder leakage.

  1. Bromelain

This is an enzyme found in pineapple plant. It has powerful anti-inflammatory abilities and prevents bladder irritation. Therefore, it has a positive effect on those with an overactive bladder.

  1. Cornsilk

Cornsilk refers to the hair-like threads found on top of the ears of corn and beneath cornhusks. It is rich in flavonoids and is helpful in relieving bladder control symptoms by reducing inflammation and protecting the bladder wall against irritation.

  1. Cleavers

This is a wild flower with tiny hooks on its stems, seeds, and leaves. It reduces bladder inflammation and protects the bladder wall from irritation.

At Advanced Urology Institute, we are known for our comprehensive, accurate diagnosis and tailored approach to treating urological disorders. With an overactive bladder, we make sure to establish the underlying cause, whether weak or stretched pelvic floor muscles, an enlarged prostate, chronic UTI, obesity, diabetes, or a nerve problem. 

Then, as first-line treatment, we often recommend natural remedies such as behavioral, lifestyle and dietary changes. For a more bothersome and persistent overactive bladder, we offer a variety of surgical and non-surgical interventions.

For more information on an overactive bladder and other urological disorders, visit the site “Advanced Urology Institute.”

Medtronic’s InterStim Therapy for Incontinence with Dr. Ali Syed

You have probably heard the term incontinence, but do you really know what it is? Incontinence is loss of control of a person’s bowels or bladder that results in accidental leakage of body fluids and waste. Therefore, it’s a physical problem but also one that can diminish quality of life. Someone dealing with incontinence may avoid sex, physical activities, social outings, and hobbies out of fear they may leak urine or stool. 

 Fortunately, AUI can help with this life-altering problem. Medtronic’s InterStim Therapy, which could be called a “pacemaker for the bladder,” works great for those who have frequent urges to urinate. With surgical implantation of the InterStim device, a thin wire with a small electrode is placed near the sacral nerve. The device produces electrical impulses, which are sent to the sacral nerves and reduce hyperactivity of the bladder. 

 Dr. Ali Syed of AUI has helped countless patients enjoy a drastic improvement in quality of life thanks to InterStim therapy. 

 If you’d like to learn more about what this treatment entails, we strongly encourage you to watch the video. You can also attend one of Dr. Syed’s seminars on InterStim therapy. 

 It just might be your ticket to relief and a normal life. 


Riggio, Kristi

00:00My name is Christy Rio, and I’m. With Medtronic.

  • 00:02Some of you may
  • 00:04no medtronic as the company that invented the pacemaker back in the one thousand nine hundred and fiftys
  • 00:10tonight, Dr. Ali Sayed, with advanced Yourology Institute, will be discussing treatments that may help patients who have symptoms of overactive bladder, urinary incontinence, retention of urine, and valid continents.


Ali Syed, MD

00:24One of these treatments was developed might have been medtronic about twenty five years ago, and it’s called inner stem


Riggio, Kristi

00:32it was, It was approved on the market in one thousand nine hundred and ninety, seven, and since then patients around the world have been receiving relief from this therapy.

  • 00:41We will have a poll this evening, so please take a moment to answer the Pope questions that appear on your screen as a reminder. Everyone’s phones were muted upon entry of this Webinar, and you are muted. If you do have a question, please feel free to type it in the Q. And a box at the lower portion of your screen,
  • 00:59and the doctor will answer these questions. After the presentation.
  • 01:02Again, this presentation is being recorded.
  • 01:06There will be a short survey at the end of the presentations that you can share your thoughts.
  • 01:13I would like to at this time introduce Dr. Sayed. Dr. Sayed.


Ali Syed, MD

01:19Thank you, Christie, for the kind introduction, and I welcome everyone who has joined us this evening. So we’re going to talk about some bladder and bowel issues today. Let’s see if we can get these slides go forward.

  • 01:34All right. So surprisingly, fifty percent of patients have had incontinence, and they just have not discussed this with their doctor, whether it be their primary care, doctor, or their urologist. I often see patients in the office, and they ask questions such as will I ever regain control.
  • 01:53How can I possibly go on a date? Can I attend an outdoor celebration? I’m afraid to leave my home, you know, and the bathroom is basically always on my mind, and I map out my roots so that I know where the next bathroom is.
  • 02:06So the agenda today is to understand bladder and ballot control, to kind of figure out the care pathway, to discuss some treatment options, to discuss the meatronic inner stem system, to discuss the metronic neural system. And then we’ll answer some questions.
  • 02:22So
  • 02:23the thing that Ah amazes me and amazes a lot of patients when i’m on these statistics is that overactive bladder and fecal incontinence are extremely common. Ah, one in six adults have oav or o’reactive bladder, and that accounts to thirty seven million Americans, and Similarly, one in twelve Americans have equal incontinence, and that accounts for about twenty million Americans. So compare this to something that’s common. It’s a vision problem that’s about twelve million adults or people with asthma in the Us.
  • 02:52That’s seventeen million. So way more people have overactive bladder and fecal incontents. But the biggest issue is that people don’t like talking about it because they’re embarrassed.
  • 03:03So the question is, what is normal. I often hear that I felt that i’m having a symptoms just because i’m getting older. But the reality is that urinary and balanced continents are not a normal part of aging. So people come to me with frequent accidents. I have to go now. They plan their activities around a pay bathroom. They monitor what they eat or drink, and often restrict what they drink. At the time of events, and often are using pads and protection


Unknown Speaker

03:33of garments.


Ali Syed, MD

03:36So it’s kind of important to know what the normal physiology is. So the question is, how does bladder control work so normally? Your kidneys? Ah, make urine, and the urine is stored in the bladder. When the bladder is about half full. It stimulates your nerves by telling your brain, hey? If I have to go to the bathroom, and then the job of the brain is to coordinate your blood, or when it’s socially acceptable for you to go eat. And what happens in whole rack of bladder is

  • 04:01the control between the nervous system and the bladder breaks down, and therefore the social cue is gone away, so you cannot control. Hey? I don’t have a bathroom nearby. I want to hold on. That does not exist any.
  • 04:14Similarly, bowel control works in a very similar fashion. So when you eat the digestive system pushes the food through your intestine. Ultimately it reaches the rectum, and when the rectum is full it stimulates your nerves, or or sends a signal to your brain,
  • 04:28saying, Hey, is it socially acceptable for me to go have a development, and if it’s not, your brain tells you, ruptum to know. Find a bathroom. Wait, and when you do it it relaxes. You speak for muscle.
  • 04:42And similarly, when there’s a communication breakdown between the brain and the rectum, it causes issues with controlling your bowel movements.
  • 04:51So what causes incontinence on various different things. So there’s daily habits in regards to what you’re eating and drinking.
  • 04:57Ah! Sometimes medications can cause incontinence. Sometimes reduced. Physical mobility can be associated with incontinence, and finally, common things, such as pregnancy, childbirth, radiation, public for injury, Previous surgeries of the public prostate surgery and men all of these things can be associated with
  • 05:17um ordinary incontinence.
  • 05:21So there’s three common bladder control problems that we often see. One is stress urinary continents, and we’ll. We’ll define this a little bit more. But the key here is that stress urinary content is not treated by the metronic system. There’s urinary retention, and then there’s all proactive bladder, which also has spurging on it. That’s where you have to go, and you have accidents in trying to make to the back.
  • 05:43So as they mentioned. So what is stress you’re in on this. So this is the leeches that we experience when you sneeze when you cough and you laugh, or if you get up to quite well, if you’re exercising um, you’re going up the stairs. Then you experience a little ticket. So this is the accident that happens with activity, really. And this, again, is not treated by the electronic system. There are other treatment modalities for this that exist that we’re not talking about today. But this is a treatable condition.
  • 06:11Next, what is your area of attention? So this is a feeling where you can’t tell your bladder’s full, or you know it’s full, but you’re unable to empty it. And sometimes the symptoms that are associated with it is weak dribbling, screening. Sometimes you have to use a Cath, that I’ve seen patients that come to me with a cat in place. And so that is your in your retention, and we work that up to see if it can be fixed by a stimulator.
  • 06:37And finally, what is overactive water so overactive bladder has two components: urge incontinence and emergency frequency. So what urgentontinence means is that you start going before you reach the bathroom, meaning you have accidents before you can make it to the bathroom, and often you’re wearing pads and effective garments out of embarrassment. You’re in a frequency something similar. Basically it’s you have to go to the bathroom quite frequently throughout the day. And that’s more than that’s defined as more than eight times.
  • 07:07The only good thing here is that you’re not having accidents, so you have to go real bad. You are able to make the bathroom, or you’re going back. And again, patients tell me things like, hey? I never drink a meeting, or when I go out for dinner. I don’t drink much, because i’m worried about having an accident.
  • 07:24Finally, what is fecal incontinence? This is a entity that again is quite common, but unfortunately, people are embarrassed to talk about it. But basically this is a origin continents which is an inability to resist the urge to go, and you have an accident with your stool, and similarly passive incontinence is the inability to feel the need to go to the bathroom.
  • 07:49So the good news is, There are various treatment options, and all of them have a good success rate. We’ll discuss some of them. So basically the pathway in diagnosing this is when you come to the office to run some tests. We make a diagnosis to see what type of income and survival issues we have.
  • 08:06Then we usually recommend dietary and lifestyle changes. If that doesn’t work we out of medication, and if that doesn’t work, then we really discuss some advanced therapies.
  • 08:17So again, there’s some simple solutions, Lifestyle and dietary changes often helps
  • 08:21many people, and that includes limiting fluids that are bladder, irritants, exercising and and pelvic fluor. Physical therapy often helps
  • 08:31that doesn’t work, we add some oral medications. Um. The benefit of medication is, It’s a you have to take. However, there are some downsides, and it basically is a lifelong medication that you have to take, and unfortunately, some of the good medication that we have have side effects on the market that include dry mouth, which inevitably makes you drink more water, and therefore you’re going more often to the bathroom. Ah, blurry vision or dry eyes, constipation which can worsen urinary symptoms and also high blood pressure.
  • 09:00In fact, there was a recent survey that seventy two percent of people stop taking their blood or medication due to these side effects. So it’s not a really a good long-term option.
  • 09:11Then there are advanced therapies that we kind of talk about once the medical treatment Haven’t worked and for bladder control. This really is a metronic inner stem system which we’ll talk about. The metronic nervous system and injected medication, such as poc
  • 09:26for bowel-control adoption is slightly more limited, but also very good, and that includes the electronic intersection system and some surgical options with regards to the Enol speaker.
  • 09:38So again, there’s risks and benefits of each, and we’ll review a little bit of it. So Botox um is a medication that’s used to treat overactive bladder that’s injected into the bladder muscle through a needle. Um, and it’s a it’s It’s quite comparable to oral medication. The downside is that it does each of you repeated every ah few months as it loses efficacy. Um! For a period of four months or so it also does not treat eco in the continents, and there is a small percentage of people that have to
  • 10:08rely on cathedralizing because the Botox worked too well. So with that said, You know, fifty one percent of the patient do stop the treatment after concessions, mostly because people don’t want to keep on going through the injection treatment every few months.
  • 10:23The ptnmetronic neurosystem is also a very safe, effective, minimal, invasive. Ah, therapy! It’s shown to reduce urgency, frequency and urine content, and sixty seventy percent of patients Um, It restores bladder function by gently stimulating the trivial nerves. But it does not treat people in common. Um! And it’s very safely to del delivered in the office environment. It’s a thirty minute session. It takes a you know, one session for a week, and if you’re released from that then we kind of start
  • 10:53the maintenance sessions for long-term relief. So the benefit is it’s quick, easy, minimal, invasive. The downside is you need to have persistent treatment to maintain your symptomatology?
  • 11:05And Finally, the sacred neuromodulation mechanics system is a system that basically corrects what the pathology is. So, as I mentioned, the issue again, is a breakdown in the communication between the brain, the bladder and the valve. And what this stimulator does is that it restores that function. The benefit is that there’s actually a test that we do in the office that i’ll talk about shortly to see if it’s a very good candidate for.
  • 11:35And before I move on, actually, this this system has been on the market for well over twenty years, and it’s Fda for all of the indication that we’re talking about with pretty high success Raiders and studies that show over eighty, five to ninety percent success rate in reducing the symptoms over fifty percent. So the evaluation is quite simple. The test is done in the office or an outpatient center, and we basically place a thin wire
  • 12:03in the upper part of the butt off. It takes about twenty to thirty minutes. You’re awake for this part, and then the leads attach to an external device, as shown on the patient. Here, with a little belt,
  • 12:16and over a period of three to seven days or so. We adjust various programs to see if you’re symptoms, and if your symptoms improved over fifty percent from where we were when we started. Then we say, Hey, this is a good treatment option for you, And then we kind of decide on the permanent implant.
  • 12:36So again, the technology it has been around for several years. It’s safe and effective. It has good data, showing how well it works. In fact, eighty nine percent of people who, using the electronic of valid controlled therapy experience, long-term success.
  • 12:51And similarly, seventy six percent of patients experience success with their bladder control. Which is way more compared to medications, which is under forty nine percent.
  • 13:02So is this the right therapy for everyone? Um. The answer. The short answer is, No, we do an evaluation in the office. See what type of incontinence you have. Ah, what type of ecal incontinence you have! Ah, evaluate your blotter and make sure everything else is healthy, and then we decide if it’s the right therapy. And again, if it is there’s a quick and easy test that can be done in the office for an operating center to see if it will work for you before we put the full thing
  • 13:32all right, and that’s the conclusion. So i’m happy to take any questions at this point, and I hope this was informative for everyone that joined us this evening.
  • 13:45Okay, thank you, Dr. Sayed. For that presentation. I do have a lot of questions actually, that have come in during the talk, so I will get started.


Riggio, Kristi

13:58One of the first questions is, Can I get an Mri with the inner stem system.


Ali Syed, MD

14:03That that’s an excellent question. And the short answer is, yes, Historically, the answer was no. But recently we’ve been able to develop technology where the Mri is completely safe with the system.


Riggio, Kristi

14:17Okay, Okay, Thank you. Um. If you do want to ask a question, just feel free to click the Q. And a button on your screen, and there you can type in your questions. Um, here I have a couple more that have come in um. Do you see most of your patients, do you see? Do most of your patients see good results

  • 14:36from the test? And I guess this is also tests, says tests,
  • 14:42implants.


Ali Syed, MD

14:44Yeah, that’s a great question. Um, I would say about, you know. Do you appropriately select the patient um about eighty to ninety percent of my patients about excess success. Um with the test. If the test in the office doesn’t work, there is an advanced test that we do in the surgery center um where the permanently displaced and often uh five to ten percent of those patients will respond as well. Um. So overall. I think that rate in my practice it’s the eighty-five to ninety percent which is comparable to the long


Unknown Speaker

15:14can be it like this:


Riggio, Kristi



Ali Syed, MD

15:17And The one thing i’d like to add is, I think, the biggest thing that’s underutilized is for fecal incontinence. It’s amazing how how those patients have significant restoration of their quality of life after this device, and often i’ll here, you know i’ll do it for urinary complaints, because that’s what the picture comes to me for, and often after the fact, i’ll hear, Hey, my my mouths are way better,

  • 15:39because people just don’t like talking about the fecal incontinence part. But that’s where it’s a really unique therapy.


Riggio, Kristi

15:48Well, that was great, because that was one of the questions that came in. Dr. Sad was Um, if it worked for bowel control, so we’ll move on to the next one. Then we already answered the question with the Mri. So that was the answer asked again.

  • 16:06Then that again asking about ball and continents that was asked. That’s another one.
  • 16:14Here was one. Um! What is the recovery after the test? And then also, what is the recovery after the implants?


Ali Syed, MD

16:24So. Ah,

  • 16:25yeah, that’s that’s a great question. So after the test, the recovery isn’t so much So in the sense that you don’t really have any restrictions except no flu, goals and
  • 16:36and fast until the weeds are in. So that’s again about three to five days. There are no incisions or cuts on you. The the the Tesla’s are deployed all through a little needle, so there’s not much recovery. Um, in that sense, except for three days you have the weeds, and then, after the implant, the recovery is about two weeks, so for pain can. The biggest incision you have is about three to four centimeters in the buttock, and the biggest restriction again I have is
  • 17:04avoiding swimming pools that as oceans is to prevent infection um pain. Most people are pretty minimal. I just have Tylenol and emotion um for pain control, and the results are pretty pretty immediate, and that you see with it once the system is installed,
  • 17:20and also The other thing to to note is that nowadays with metronic, the system lasts up to ten to fifteen years. So you don’t really need to change anything or change the battery unless there’s an accident or a fall which breaks the lead, and then you need to change it out.


Riggio, Kristi

17:37Okay, perfect. That was That was one of the next questions was, How long does it last? So you answered that

  • 17:43question, and then the other one is I I guess you did it. Can you see the device under the skin?


Ali Syed, MD

17:51Um, no, you can feel it, but you definitely cannot uh see it. So we put it in the uh in the buttock, so you can see the incision on the outside. But you can’t see the device.


Riggio, Kristi

18:02Okay? Next question is, can you?

  • 18:06I guess the question is, can you manipulate the device? Um, once you have the have the implants, so can I? I guess you’re asking if you can make changes or change.


Ali Syed, MD

18:16Yeah. So you know, It’s controlled through like a little telephone like a smartphone, and there are various programs that can be changed. Um, in terms of physically moving the device. It shouldn’t move unless there’s again a fall or a trauma of some sort. But you can adjust the programs, and you know, check it and make sure it’s working well and stuff like that.


Riggio, Kristi



Ali Syed, MD

18:37Um. Is there an age range for? Is there an age where a a patient can no longer get this device. Um! Was one of the questions

  • 18:47right great question. So from the Fda there’s no age limit on who can get the device, and who can, from my perspective as a physician. Obviously,
  • 18:57I would want to not put anyone who has multiple medical issues under anesthesia and stuff like that. So you know we make sure you’re healthy enough to undergo the procedure before we do it. But there’s no age restriction that I’ve had good results with people in their late eighty S. For example. And similarly, I’ve had excellent results with someone in their thirty S. So there’s really no age restriction. In fact, in my training. We did it in the pediatric world with with good success.


Riggio, Kristi

19:23Okay, where is this? Where Where is the test and implants performed?


Ali Syed, MD

19:32So it’s usually performed either the implants performed at a survey center, and the test is usually also performed in an outpatient center, and rarely in the


Riggio, Kristi

19:43and I think That looks like all the questions. There was a couple of duplicates here. Oh, there was one here. What about a Tsa security check?


Ali Syed, MD

19:53That’s a That’s a great question. So electronic gives a little implant hard to shape it to show that you have a little bit of a given an implant in there, and I haven’t heard any issues. Kristy, Have you heard of any issues with this?

  • 20:05No, that that was something. That was the case many, many years ago, but no no no longer Patients um bring their car. They say they have a medically implanted device. Usually the the Ts agent will ask, Where is that? By the planet, and they’ll just use the wand they Won’t have you go into the X-ray machine
  • 20:24it doesn’t have anything it won’t damage the um implants whatsoever. If you were to go into the um the X-ray machine, but they just they just wand you instead. Um, I guess that’s their protocol for safety from the Tsa. There’s no


Riggio, Kristi

20:42no interaction,

  • 20:46so I guess that was all of the questions. Thank you all for your time and participation tonight in the Webinar Um. You can see back our seeds information on the screen. He’s both in Palm Harbor and in Trinity, and you’ll see his phone number there, and you can give the office a call to make an appointment to see him see if he would be a candidate
  • 21:07for inner stem.


Ali Syed, MD

21:10Awesome? Yeah, no, uh Kristy, Thank you for hosting this, and again I appreciate all everyone joining this evening and spending some time with us to learn about incontinence.

  • 21:21Thank you. Thank you all. Good night.


Make an Appointment with Dr. Ali Syed Today

Palm Harbor Office

35095 US Hwy 19N, Suite 202
Palm Harbor, FL 34684

(727) 771-0600

Trinity Office

2148 Duck Slough Blvd., Suite 102-103
New Port Richey, FL 34655

(727) 375-1975

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


  • 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.”


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.


Advanced Urology Institute Recognized as an Axonics® Center of Excellence

Dr. Carole Gordon is an expert at treating bladder and bowel dysfunction with innovative Axonics Therapy

April 20, 2021

Advanced Urology Institute has been designated an Axonics Center of Excellence by Axonics Modulation Technologies, Inc. The designation recognizes the AUI team and Dr. Carole Gordon for her expertise with Axonics Therapy and sincere commitment to changing the lives of patients suffering from bladder and bowel dysfunction.

Today, millions of Americans suffer from overactive bladder and fecal incontinence.1 Patients in the Villages, Leesburg, and Ocala areas with chronic and debilitating symptoms related to bladder and bowel dysfunction may seek treatment from the experts at AUI. Axonics Therapy gently stimulates the sacral nerve (sacra neuromodulation), restoring normal communication between the brain and the bladder. Axonics Therapy has been clinically proven to provide rapid and long-lasting relief of symptoms associated with bladder and bowel dysfunction.

In a clinical study, 129 patients with urgency incontinence were treated with Axonics Therapy At 2-years, 93% of patients had successful therapy and 94% of patients were satisfied with theirtherapy.2

The Axonics Center of Excellence program recognizes highly trained and experienced physicians (typically urologists, urogynecologists, and colorectal surgeons) and clinical practices that are committed to patient education and providing exemplary care to achieve optimal clinical outcomes and patient satisfaction.

“AUI is proud to be recognized as a Center of Excellence. This designation is a testament to the dedication of our entire team, and in particular to Dr. Carole Gordon,” said Gina Barnes, Chief Administrative Officer. “We are committed to providing the best care to our patients and are extremely pleased to offer Axonics Therapy.”

About Advanced Urology Institute

As one of the largest full-service urology groups Florida, our 37 locations offer comprehensive urology services, from evaluation and pre-surgical preparation to surgery and rehabilitation. We have evaluated numerous patients and performed thousands of urologic surgical and cancer procedures in the last decade with excellent outcomes. We are dedicated to combining clinical excellence, advanced technology, and patient-centered care.

For more information contact AUI at: 855-977-4888

About Axonics Modulation Technologies, Inc. and Sacral Neuromodulation

Axonics, based in Irvine, Calif., has developed and is commercializing novel implantable SNM devices for patients with urinary and bowel dysfunction. These conditions are caused by a miscommunication between the bladder and the brain and significantly impacts quality of life.

Overactive bladder affects an estimated 87 million adults in the U.S. and Europe. Another estimated 40 million adults are reported to suffer from fecal incontinence/accidental bowel leakage. Axonics SNM therapy, which has been clinically proven to reduce symptoms and restore pelvic floor function, is now being offered at hundreds of medical centers across the U.S. and in dozens of select hospitals in Western Europe. Reimbursement coverage is well established in the U.S. and is a covered service in most European countries. The Axonics System is the first long-lived rechargeable SNM system approved for sale in the world, and the first to gain full-body MRI conditional labeling. For more information, visit

References: 1. Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P. Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int.  2011;108(7):1132-1138. 2. Pezzella A, McCrery R, Lane F, et al. Two-year outcomes of the ARTISAN-SNM study for the treatment of urinary urgency incontinence using the Axonics rechargeable sacral neuromodulation system [in press]. Neurourol Urodyn. 2021.

Common Urologic Conditions Are Treatable

The urinary system of the human body regulates, manages and eliminates urine waste. The organs in this system are the kidneys, ureters, bladder and urethra. But as with any organ or system of the body, the urinary system can have problems, commonly referred to as urologic diseases or urologic problems.

You can have urologic problems regardless of your age, ethnicity or gender. And when urologic conditions occur, in both men and women they have a direct effect on the urinary tract and how urine is expelled from the body. In men, urologic problems can also affect the reproductive organs.

Signs that you have urinary tract problems:

Urologic conditions are treatable

Urology is a dynamic and advanced field. Urologists know how to treat many urologic diseases, including cancer of the prostate. The first step in any successful treatment is to see a urologist on time. Do not delay. As soon as you experience any problems, visit a urologist for a medical exam.
Mikhail Lezhak, PA-C of Daytona, FL

Common urologic conditions

(1) Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are the most frequent type of urologic condition, although they occur more commonly in women than men. Close to 60% of women and 12% of men experience UTIs at some point in their lives. These infections are easily treated with antibiotics, but the treatment should begin as soon as possible to avoid further infection and prevent complications.

(2) Urinary incontinence

Although many people resist seeking help because of embarrassment, urinary incontinence is treatable in most cases. The cause is usually either an overactive bladder (urge incontinence) or stress incontinence. Typically, urge symptoms come from the bladder wall and detrusor muscle and mucosa, while stress symptoms are due to the incompetence of the bladder neck or urethral sphincter.

The diagnosis of urinary incontinence can be reached through a careful patient history, thorough examination and proper tests. You may need bladder retraining, controlled fluid intake, reduction in caffeine intake, or deliberate delayed voiding to treat the symptoms. Your doctor can also recommend medication or perform corrective surgery.

(3) Pelvic Floor Dysfunction

Pelvic floor muscles support the bladder, vagina and rectum. At some point in life, particularly after childbirth, pelvic floor muscles can become irritated or inflamed. Since the pelvic floor has to relax during urination, having pelvic floor dysfunction can cause pain or difficulties. The problem is often treated through pelvic floor exercise, but when the exercises are ineffective, vaginal medications or muscle injections can be used.

(4) Prostatitis

Many urological problems in men are linked to the prostate. Prostatitis is the inflammation or abnormal swelling of the prostate. The most common symptoms of prostatitis are painful urination, fever, chills, abdominal pain, and pain in the lower back or pelvic region. If you are diagnosed with prostatitis, your doctor will recommend antibiotics to reduce the swelling and restore your prostate to normal size.

(5) Bladder and prostate cancer

The PSA test and prostate exam are great ways to check on your prostate health. Should cancer be found in your bladder or prostate, your urologist will offer lifesaving care. Prostate cancer is the second leading cause of cancer-related deaths in men. It results from the abnormal and rapid growth of prostate cells.

Prostate cancer is successfully treated when detected early, which is why men are encouraged to get checked once a year. In fact, the recommended treatment depends on the time of detection, and may include radiation, surgery or regular surveillance. Today, robotic surgery has helped to reduce the hospital stay for kidney, bladder or prostate cancer surgery to just a few days, or just one day.

(6) Prostate enlargement (BPH)

The prostate grows as you age. Over time, you may have to wake up at night to go to the bathroom or you may not be able to produce the stream of urine you once did. When diagnosed with BPH, your urologist will use various techniques to relieve the obstruction caused by the enlarged prostate. These techniques include consistent monitoring, medications, and in some cases surgery.

Your urologist may also recommend the Rezum procedure—which uses heated water vapor to shrink the enlarged prostate tissue—or the green light and thulium laser vaporization techniques, transurethral resection of the prostate, minimally-invasive thermotherapy, or a UroLift. You will likely return home the same day as one of these procedures.

(7) Erectile dysfunction (ED)

This is a common condition as men grow older. When a man in his 40s or 50s notices that his erections are no longer what they used to be, he should talk to a urologist. Erectile dysfunction is the difficulty in achieving or maintaining an erection for sexual intercourse.

Although not fatal, it can cause stress, embarrassment and a strain on your relationship. Urologists will help you determine the underlying conditions and recommend treatments. Your urologist may prescribe medications—such as PDE5 inhibitors Cialis and Tadalafil—penile injections, a penile pump or, as a last resort, penile implant surgery.

(8) Kidney and ureteral stones

Kidney and ureteral stones occur when crystal-like particles in urine develop and grow into larger masses. As the stones pass along the urinary tract, they can get blocked and cause pain. Although most stones are passed naturally, larger stones may require surgery or specific procedures to break them.

One of the most common treatments is the Extracorporeal Shock Wave Lithotripsy (ESWL) technique in which sound waves are used to break up stones into smaller pieces. Also, since kidney stones can recur, patients often need long-term care. Your urologist will advise you on how to prevent kidney stone formation and how to best manage any potentially painful stones that develop.

At Advanced Urology Institute, every day we help people solve problems they may be hesitant to talk about. Since these problems are distressing or awkward to discuss, our goal is to help make you comfortable. We are proud of the long-term relationships we enjoy with our patients. Our knowledgeable urological specialists provide carefully tailored and confidential care. At AUI, patients get a proper diagnosis and the correct treatment, and we are willing to answer any questions you may have about your health.

If you suspect you have a urological problem, we encourage you to make an appointment at one of our many locations. For additional educational resources on urologic conditions, visit the Advanced Urology Institute website.

5 Reasons for Women to See a Urologist

A urologist isn’t just a doctor for men. There are many reasons why a woman would need to see a doctor who treats the urinary system. The urinary system is a collection of organs that involved the kidneys and bladder, as well as the organs involved in the reproductive process.

Here are five common reasons why a woman may need to see a urologist

1. Kidney Stones

When minerals in the urine combine, they can sometimes stick together and create kidney stones that get lodged in the urinary tract. These stones vary in size and create a variety of symptoms. The most common symptoms are pain and difficulty urinating. Some women may also experience fever or chills.

Treatment for kidney stones varies depending on patient and stone type, but urologists have plenty of treatment options on hand. In some cases, drinking lots of water can flush the stones out. In other cases, high-intensity focused ultrasounds can break the stones into smaller, more easily passable pieces.

2. Urinary Tract Infection

Commonly referred to as UTI, this a common infection that many women will develop at some point in their lives. It occurs when bacteria enter the urinary tract and cause pain and burning during urination. UTI’s can become serious, so treatment with antibiotics is important.

3. Bladder/Pelvic Prolapse

This painful condition occurs when the bladder begins to drop down into the vagina. There are a few reasons why this may happen. Some women develop this condition after childbirth, but for others it occurs as a part of the aging process. Correcting this problem usually requires surgery performed by a urologist.

4. Bladder Control Problems

Bladder control problems are twice as common for women, and the medical term for these problems is Urinary Incontinence. Urinary incontinence takes many forms. Some women experience dripping when they sneeze, cough or laugh. Some women have an overactive bladder that creates a sudden and urgent need to use the bathroom. No matter what form it takes, women can work with a urologist to find the best treatment, or combination of treatments, to help with their incontinence.

5. Cancer

There are certain cancers for which a woman would be treated by a urologist. These include cancers of the bladder, kidneys or urethra. Lower back pain, pain during urination, and blood in the urine can be signs of one or more of these cancers. Treatment varies depending on the type of cancer, how aggressive it is, and the overall health of the patient.

Women in Florida who need a urologist for treatment of one or more of these problems have many options. The Advance Urology Institute is a team of highly skilled medical professionals who practice at locations throughout the state and with a commitment to achieving the best possible outcomes for their male and female patients. For more information about women’s urological issues, visit the Advance Urology Institute website.

What Female Urology Conditions Can Dr. Jonathan Jay Treat?


  • Dr. Jonathan Jay is a board-certified urologist with a fellowship in female urology, voiding dysfunction, and pelvic floor dysfunction, who treats a variety of urinary problems common in aging women, such as incontinence, overactive bladder, pelvic organ prolapse, and pelvic floor dysfunction.
  • A range of treatments is available in urology, with the least invasive options prioritized, including physical and behavioral therapies, nerve therapy, Botox injections, bladder pacemakers, pessaries, and medications; surgery is considered a last resort.
  • Most urinary problems are not life-threatening but significantly impact the quality of life; by resolving them, urologists can restore confidence, meaning, and hope to their patients’ lives, with most patients experiencing good results from minimally invasive procedures.

I am Dr. Jonathan Jay, a board certified urologist with Advanced Urology Institute. While I am board certified in general urology, I also did fellowship in female urology, voiding dysfunction and pelvic floor dysfunction.

Dr. Jonathan Jay of Naples, FLOne of the inevitable consequences of aging in women is urinary problems. With increasing age, the pelvic floor muscles—a group of muscles that support the bladder, vagina and rectum—face the risk of damage. Since these muscles need to relax in order to pass urine well or have smooth bowel movement, their disruption may result in urinary problems, such as incontinence, overactive bladder, pelvic organ prolapse or pelvic floor dysfunction. Tension in these muscles may also lead to pain during sexual intercourse, painful or frequent urination and lower back pain.

Aging and urinary problems

As women age, they may develop and overactive bladder, which means they urinate at all hours and with little warning. Many women suffer from incontinence after childbirth, a condition characterized by unintentional leakage of urine when coughing, sneezing, laughing or jumping. Childbirth may also cause injury to the pelvic floor muscles leading to weak spots in the walls and muscles of the vagina when adjacent organs move from their normal positions resulting in pelvic organ prolapse.

Informed decision-making

Unlike other specialties, such as neurology and oncology, urology offers a range of treatments that deliver great results for these conditions. Actually, most patients do get better after intervention by a urologist.

In fact, one of the reasons I chose this profession is that there are so many ways to help rectify problems and restore normalcy to people’s lives. As a urologist, I get the opportunity to care for patients in their declining years when urologic problems are so common. I care about both their medical and emotional challenges.

As urologists, we have the ability to find your problem when you present with symptoms. Once the problem is identified, we educate you on what you need to do and talk with you about the different treatment options available. I like counseling patients; talking to them about the bigger picture and helping them make informed decisions.

And as we define these problems, educate patients and talk about the different treatment options available, especially the positives and negatives, we help our patients to make choices that they are comfortable with. Still, because we understand that these choices have risks, we ensure that we provide enough information to minimize the risks.

Most urinary problems are not life-threatening, but are quality of life issues. That means that by resolving them, we restore confidence, meaning and hope into our patients’ lives.

What does the treatment involve?

When we make choices for treating urinary problems, we prioritize the least invasive procedures in order to minimize the risks. Typical treatment begins with a physical examination and evaluation followed by a discussion of options such as physical and behavioral therapies–including exercises to build strength in pelvic floor muscles–and reducing water, alcohol and caffeine intake.

As an option for treating overactive bladder, we may recommend nerve therapy, a procedure which involves placing a needle in the ankle to transmit electric stimulation to the nerves that control bladder function. We may also recommend more invasive options for overactive bladder such as Botox injections and an implantable bladder pacemaker.

Depending on the symptoms, we may choose to manage pelvic organ prolapse using silicon or rubber diaphragm called a pessary, which is inserted into the vagina to support the pelvic floor. We may also recommend vaginal medications or muscle injections to help with pelvic floor dysfunction. But if the problem persists or worsens even with these interventions, we may explore surgery as a last resort.

Remarkable outcomes

In urology, we are fortunate that most of the problems are clearly defined, the treatment path is clear, and the results are usually good. At Advanced Urology Institute, we offer everything, from observation, pessaries and medications to surgery. Fortunately, most of our patients do well and get better after we apply minimally invasive procedures.

We understand that many women with urological problems might not know how common and treatable these problems are—a fact that keeps them from seeking proper care. So at AUI, we try to provide information to the public so that people are aware that there are solutions for even the most awkward and uncomfortable urinary problems. For more information on female urology conditions and their treatment, visit the Advanced Urology Institute website.


I’m Jonathan Jay, I’m a board certified urologist with Advanced Urology Institute.

I’m a board certified general urologist, but I also did a fellowship in female urology and voiding dysfunction and pelvic floor reconstruction.

As women age, one of the advantages of aging is that the parts that allow them to hold urine in place and allow their bladders to be supported within the pelvis are at risk of being damaged. So hysterectomy can damage that support and those mechanisms that allow them to be continent, so can child birthing. So again, some of the advantages of womanhood predispose to some of these problems which makes it a very common problem.

And so one of the reasons I chose to be in Naples, Florida after doing that fellowship is that I knew there would be a lot of those problems to be able to rectify and treat here. And so we have the ability again to define the problem for the patient, to educate them on what they have and what their options are. These are not life threatening problems, but they’re quality of life issues and they’re major quality of life issues. And so the choices that the patients make are not one that I make, but it’s one that they make and they’re comfortable with.

For instance, we first define the problem, educate the patient, then we talk about the different options that are available and we talk about the positive and negatives of each of those options and the patient then chooses what they want to do. The outcomes are good. Remember, we’re not doing anything that the patient doesn’t want to assume the risk for.

We offer everything from observation to pessaries, say if you have prolapse, to medications if you have incontinence. We try all the benign things first and then we work our way up to surgical procedures if they have to be bothered enough to want to pursue that.


Surgical Options for Overactive Bladder

If you feel frequent, sudden urges to urinate that you cannot control, you might be suffering from overactive bladder. This condition can lead to feelings of embarrassment or shame, but it’s a common problem and can be treated in a variety of ways. For many people, overactive bladder can be treated with lifestyle changes such as special diet, weight loss, regularly timed trips to the bathroom, and exercises to strengthen the pelvic floor. Dealing with symptoms by using absorbent pads is also an option.

However, for some people, these methods are not enough to ensure they can live a healthy, fulfilling life. In these situations, surgical intervention is an option to correct overactive bladder problems.

Augmentation Cytoplasty

One of the options for treating overactive bladder is called augmentation cytoplasty. This procedure increases the size of the bladder. The surgeon accomplishes this by removing a small part of the intestine and using it to replace parts of the bladder in order to increase its capacity. For some people, this procedure allows them to resume normal bladder function. For others, the use of a catheter may be necessary for the rest of their life.

Urinary Diversion Surgery

Another surgical treatment option for overactive bladder is urinary diversion surgery. This procedure involves diverting urine from the bladder. One option for bypassing the bladder involves linking the ureters, which normally connect the kidneys to the bladder, to an ostomy bag outside of the body. Another option involves the creation of a new bladder inside of the patient’s body, which means they will be able to continue normal urinary function.

Bladder Removal

Bladder removal surgery, or a cystectomy, is the last resort option for patients with overactive bladder for whom no other treatment has been successful. For men, bladder removal surgery also involves the removal of part of the prostate; for women, it involves removal of the uterus, ovaries and part of the vagina. Because this is a risky procedure that involves multiple organs, it is usually only used for more serious urological conditions such as bladder cancer or birth defects. Removal of the bladder necessitates the use of a urinary diversion such as an ostomy bag or a stoma.

An overactive bladder can be a debilitating condition, but there are many options for treatment. If you are dealing with this issue, the physicians at Advanced Urology Institute are here to help you reach a diagnosis and find a treatment to restore your quality of life.

What is Dr. Samuel Lawindy’s contemporary approach to treating overactive bladder with InterStim Therapy?


  • InterStim therapy is a treatment option for patients with an overactive bladder, serious urine retention, or uncontrollable frequent urge to urinate, who have not responded to other treatments such as medication or physical exercises.
  • The InterStim device is implanted in the upper buttock area through a minor surgical process called Sacral Nerve Stimulation Procedure, aiming to correct the communication patterns between the sacral nerves and the brain for better bladder control.
  • The success rate of the InterStim device is high, with patients reporting relief from their symptoms almost immediately, but it is important to consult an experienced urologist to determine if a patient is a good candidate for the procedure.

InterStim therapy is a treatment option for patients with an overactive bladder, a serious case of urine retention or an uncontrollable frequent urge to urinate for reasons other than an overactive bladder. It gets its name from the InterStim, which is a small implantable device used to administer the therapy. There are other forms of treatment for overactive bladders, including medication and physical exercises. InterStim Therapy is used for patients who have failed to respond to the other treatments or who cannot undergo the treatments.

What is an Overactive Bladder?

Dr. Samuel LawindyAn overactive bladder is a condition characterized by sudden, frequent and uncontrollable urges to urinate. The patient feels the need to go to the bathroom numerous times during the day and the night. Sometimes, due to the uncontrollable nature of the urge, patients may have urine leakage, also known as urinary incontinence.

An overactive bladder may be caused by a neurological condition that interferes with the functioning of nerves that transmit messages between the brain and the bladder. Contributing factors can include diabetes, bladder complications such as tumors or stones, urine retention and an excessive intake of fluids.

InterStim therapy is focused on fixing the disconnect between the nerves in the brain and those that control bladder function.

The Procedure

The InterStim device is implanted in the upper buttock area through a minor surgical process called a Sacral Nerve Stimulation Procedure. Sacral nerves are located around the tailbone and regulate the operation of a person’s urinary function. Bladder movements are determined by the communication between the sacral nerves and the brain.

In patients suffering from an overactive bladder or urge incontinence, an InterStim device is implanted to enhance or correct the communication patterns between the sacral nerves and the brain, ensuring the person has full bladder control. Before the actual InterStim device is implanted, doctors place a temporary stimulator to observe how the patient responds. This helps to project what the efficiency of a permanent stimulator will be. If the patient does not respond at all to the temporary stimulator, then it would not help to implant a permanent one.

The success rate of the InterStim device is high, with patients reporting relief from their symptoms almost immediately. It is important to consult a urologist before having the device implanted because not every person may be a good candidate for the procedure. Since the surgery is a relatively delicate one, a patient should make sure to see an experienced urologist from a reputable institution, such as those from the Advanced Urology Institute. The staff of experts at Advanced Urology Institute can help with any questions, preparations and surgery. For more information, visit the Advanced Urology Institute website.


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

For patients who have significant urge, urinary incontinence and urgency and frequency and medications have not quite treated that, there are a couple other options.

The inner stem is a nerve stimulation test that can not really test but a treatment for overactive bladder that it requires a small implantable device that goes into the upper buttocks that then stimulates the nerves to the spine that goes to the bladder to calm it down so that it gives you complete control over your urinary symptoms with no more leakage and more sleep throughout the night really.

And you don’t really have to think about it, it’s in there, it’s like a little pacemaker for the bladder, you control it with a little phone and you can adjust the settings that way.


Causes of a Weak Urine Flow

The inability to start or maintain urine flow, causing dribbling or weak urine flow, is called urinary hesitancy. It can occur at any age for all genders, but it is by far most common among aging men. Urinary hesitancy develops gradually but if left untreated, it can lead to a complete inability to pass urine, also known as urine retention. Due to its prevalence among older men, weak urine flow has always been associated with an enlarged prostate gland, a condition very common in older men. This, however, is not the only cause of a weak urine flow.

Causes of a weak Urine Flow

1. Benign Prostate Hyperplasia (BPH)

Benign prostate hyperplasia is the medical term for an enlarged prostate. As a man ages, the prostate grows to a size larger than what is normal. The prostate’s location around the tip of the urethra means that the enlarged prostate presses on the urethra and blocks the passage of urine. This whole or partial obstruction slows down the flow of urine. BPH is the main cause of a weak urine flow in men over the age of 45.

2. Underactive Bladder (UAB)

Dr. Jonathan Jay: Naples, FLAn underactive bladder is a medical condition characterized by weak urine flow and an inability to empty the bladder completely. The condition is best understood as the opposite of the overactive bladder (OAB) which has received wider attention and is known to cause urinary incontinence, the urgent and frequent urges to urinate. Patients suffering from an underactive bladder have a diminished sense of when their bladder is full and are not able to contract the bladder fully. The condition can occur when there is damage to the bladder peripheral pathways or to the lumbosacral spinal cord. It is also common in patients suffering from diabetes mellitus, neurological diseases, Parkinson’s disease and pelvic fractures.

3. Bladder Outlet Obstruction (BOO)

As the name suggests, this is a condition that occurs when there is a blockage at the neck or the base of the bladder. The blockage completely prevents or reduces urine flow from the bladder. It occurs in both women and men, but is more common in older men. It can be caused by bladder stones, scar tissue in the urethra, bladder cancer or an enlarged prostate.

It is clear that weak urine flow has a variety of causes. It is very important to see a urologist to determine the exact cause of a weak flow. An appropriate plan of treatment can be set up once it has been determined what is creating the problem. It is recommended that you consider seeking out trained, experienced and board approved urologists if you are having problems with weak urine flow.

At AUI, we offer patient-friendly and multidisciplinary urology services for a wide range of problems, including weak urine flow. For more information, visit the “Advanced Urology Institute” site.

For more information, visit the “Advanced Urology Institute” website.

What Does Dr. Nicole Szell Say About Women’s Urinary Incontinence?


  • Urinary incontinence in women can be classified into different types, such as stress or urge incontinence, which require different treatment approaches.
  • Treatment for urinary incontinence can involve lifestyle changes, pelvic floor exercises, medications, and in some cases, surgery.
  • It’s essential to consult a urologist for appropriate diagnosis and treatment for urinary incontinence to improve symptoms and quality of life.

When you complain to us about urinary incontinence, we will take quick vital steps to help you. For instance, if you are able to immediately provide a clean-catch urine sample, we will do a urinalysis to rule out urinary tract infection. We also will ask you to keep a three-day voiding diary to enable us to classify and identify the cause and severity of your incontinence. Then we will schedule a follow-up visit before we begin treatment to review the timing, quantity, severity and circumstances of your typical episodes of urine leakage, particularly those that you find most troubling.

Types of Urinary Incontinence

The treatment approach we adopt for each case depends on the type of incontinence and severity of symptoms. In women, the most common types are stress or urge incontinence, but some women may have mixed incontinence, where urge and stress incontinence occur simultaneously. When episodes of urine leakage occur following a physical act like sneezing, coughing, heavy lifting or bending over, that is stress incontinence. On the other hand, urine loss associated with a strong uncontrollable need to void is urge incontinence. So we will use the three-day voiding diary, medical history, physical exam and any necessary tests to determine what type of incontinence you have in order to administer the right treatment.

Lifestyle Changes

Once the type of incontinence is determined, we will embark on appropriate treatment for your condition. For example, if we find that you have early-stage incontinence with rare or less troubling symptoms, we will reassure you that your condition is not that bad and recommend a number of lifestyle changes to improve your situation. We are good at building close and abiding relationships with our patients, so we will explain the diagnosis caringly and instruct you compassionately on what lifestyle changes we want you to make. For instance, since timed voiding is quite helpful with nocturnal urge incontinence, we may instruct that you set an alarm every night an hour before the usual time you wake up with a deep sense of urgency and empty your bladder before it gets full to the point of leakage. We also may advise that you reduce your overall fluid intake, avoid caffeine, spicy foods or carbonated drinks.

Pelvic Floor Exercises

We often recommend Kegel (pelvic floor) exercises for women with stress incontinence. Well-timed, regular Kegel and bladder retraining exercises help to relieve symptoms and treat the condition. We will instruct you on the right technique for these exercises and work with you on a plan to help you practice them until they become second nature. We recommend that you begin by exercising the pelvic floor muscles 4 times a day and gradually increase this to 8 times a day, making sure also to use bladder retraining exercises to increase the interval of time you take between your bathroom visits. We will guide you all the way, checking on you to find out if there is any relief from the symptoms as you implement the exercise regimen.

Anticholinergic Medications

In case of a severe, debilitating urinary incontinence with very bothersome and embarrassing symptoms, we may give anticholinergic (anti-muscarinic) medications to eliminate bladder spasms and relieve the symptoms of incontinence. Some common medications we may recommend include Detrol, Vesicare, Ditropan XL, Enablex, Urispas and Oxytrol, with Oxytrol being available even without prescription. Apart from medications, we may advise you to use absorbent pads, panty liners or similar products, to prevent urine leakage or possible embarrassment from a potential leakage. A good example is the pessary, a plastic insert into the vagina, which we may recommend for supporting your bladder’s neck and preventing urine leakage associated with stress incontinence.


If these treatments fail to give enough relief, we may opt for surgery. For instance, we may surgically implant small nerve stimulators just beneath your skin to stimulate the nerves controlling the pelvic floor area and manipulate the contraction of the muscles within your pelvic floor. Or we may opt for the sling procedure, a surgical intervention in which a strap of natural tissue or synthetic mesh is added to support the urethra. We also may conduct procedures to restore your bladder to its original position.

Are you worried about urine loss when you sneeze or cough? Do you always have to stop what you are doing and rush to the bathroom whenever your bladder is full? Or do you fear going out with your friends because of a possible urine leakage? Do not suffer in silence. At Advanced Urology Institute, we have been treating urinary incontinence in women for many years and have the tools and personnel to solve your problem. Whether you just started having urine leaks recently or have had the problem for so long that you have decided to avoid the social activities you used to love, we will give you the right treatment to help you recover. For more information on treating urinary incontinence in women, visit the “Advanced Urology Institute” site.


Hi, I’m Dr. Nicole Szell, I’m a board certified urologist with Advanced Urology Institute.

I think the first thing that’s really important to understand when a patient comes in with these issues is how debilitating is it for them?

Are they in the early stages, it doesn’t bother them that much, they just need to be reassured that it’s something that happens to a lot of women, it could get worse, or it could remain the same, or is it become so debilitating to them that they are willing to have surgery or other invasive maneuvers in order to help prevent it.


Treatment Options for Urge Incontinence

Urge incontinence is not an inescapable consequence of aging. In fact, a huge majority of women with the condition have been effectively treated or helped. The trick is simply not staying at home and giving up, but visiting a urologist as soon as possible for help.

Factors that affect the treatment decision

Effective treatment of urge incontinence in women depends on the kind of incontinence, personal preferences, underlying causes and severity of the symptoms. Where the condition has more than one underlying cause, the most serious cause will be dealt with first. Likewise, your urologist most likely will opt for the least invasive treatments first before moving on to invasive ones.

Treatments for urge incontinence include:

1. Behavioral techniques

These treatments include making certain lifestyle changes to improve bladder control. They include:

  • (a) Bladder training: Entails delaying urination once the urge to pass urine comes. You can begin by holding off urine for as short as 10 minutes and then extending the holding time to hours. The goal of holding off urine each time the urge comes is to lengthen the duration between your trips to the toilet by up to 2.5 hours to 3.5 hours.
  • (b) Double voiding: Means that you urinate and then wait for only a short duration (a few minutes) then try again to pass urine. The goal of double voiding is to achieve complete emptying of the bladder to avoid overflow incontinence.
  • (c ) Scheduled toilet visits: Planning your toilet trips so that you urinate every 2-4 hours instead of waiting for the urge to come, will help you improve bladder control.
  • (d) Diet and fluid management: To improve your bladder control, you may have to cut back or avoid acidic foods, alcohol and caffeinated drinks. By increasing physical activity, reducing liquid consumption or losing weight you can ease urge

2. Pelvic floor exercises

Also called Kegel exercises, pelvic floor exercises can strengthen the muscles responsible for bladder control and urination. To help you learn and perform these exercises, your doctor may recommend that you work with a physical therapist or to try using biofeedback techniques.

3. Electrical stimulation

The urologist may choose to insert electrodes into the vagina to strengthen and stimulate your pelvic floor muscles. With gentle stimulation, urge incontinence may resolve. However, you may need several treatments over many months to be successfully treated.

4. Medications

There are several common medications that are effective in treating urge incontinence. They include:

  • (a) Anticholinergics: Include solifenacin (Vesicare), trospium (Sanctura), tolterodine (Detrol), fesoterodine (Toviaz), oxybutynin (Ditropan XL) and darifenacin (Enablex).
  • (b) Alpha blockers: These drugs relax bladder muscles and make bladder emptying easier. They include alfuzosin (Uroxatral), doxazosin (Cardura), silodosin (Rapaflo) and tamsulosin (Flomax).
  • (c) Topical estrogen: Application of a low dose of a topical estrogen, such as a vaginal patch, cream or ring can rejuvenate and tone the tissues of the vagina and urethra, helping treat urge incontinence.
  • (d) Mirabegron (Myrbetriq): This drug relaxes the muscles of the bladder, increases the quantity of urine that the bladder can hold and increases the amount of urine that can be passed at any one time. As a result, it helps to empty the bladder more completely and treats urge incontinence.

5. Medical devices and interventions

Devices such as urethral inserts and pessaries can help to treat or relieve urge incontinence. Interventional therapies such as using a sacral nerve stimulator,bulking material injections, botulinum toxin (Botox) injections and nerve stimulators also can be used to treat urge incontinence.

6. Surgery

The doctor or urologist also may use surgery to correct the underlying cause of urge incontinence. Common surgical procedures include bladder neck suspension, prolapse surgery, artificial urinary sphincter and the sling surgery procedure.

7. Catheters and absorbent pads

If the urologist finds that no medical treatment can completely eliminate the incontinence, various products can be recommended to help ease the problem, minimize discomfort and reduce the inconvenience caused by urine leakage. The most commonly used products are catheters, absorbent pads and absorbent garments.

Urge incontinence is a treatable condition. As a woman, you should not continue living with this problem since there are solutions to help you. At Advanced Urology Institute,we have helped thousands of women with urge incontinence recover from it. Come see us so we can fix the problem. For more information,
visit the “Advanced Urology Institute” site.

Common Treatment Options for Stress Incontinence

The treatment that a urologist may recommend for stress incontinence depends on how troubling the condition is to the woman and on the woman’s general fitness level. Often, the urologist will opt for fairly simple treatment options for a less troubling condition and only recommend surgical treatments when absolutely necessary. For instance, if an overactive bladder is present, the urologist will determine the possible contributing factors and recommend deterrent treatments such as fluid modification and caffeine reduction. Likewise, for women whose body mass index (BMI) is equal to or over 30kg/m2, the urologist will recommend weight loss.

Generally, the most common treatments for stress incontinence are:
  1. Weight loss: For women who are overweight or obese, losing weight helps to reduce urine leakage.
  2. Fluid management: For women who drink large amounts of fluids daily, cutting back on fluids reduces urine leakage. This includes reducing the amount of caffeinated, alcoholic and carbonated drinks. In fact, avoiding fluids 3-4 hours before going to bed helps a lot to prevent frequent nighttime urination.
  3. Avoiding constipation: Since constipation worsens urine leakage, increasing the quantity of dietary fiber to 30 grams or more per day will prevent constipation and reduce incontinence.
  4. Pelvic floor muscle exercises: Exercises for tightening pelvic floor muscles will help control stress incontinence.
  5. Bladder training: Bladder retraining helps affected women to regain bladder control and hold more urine for longer. Bladder training involves going to the bathroom on a specific schedule while awake and applying various strategies to control any sudden urges./li>
When the above options fail, the urologist may recommend:
  1. Bladder control medicines: For example, the drug duloxetine is used to treat stress incontinence in women who are unwilling or whose incontinence is unsuitable for surgical treatment. Collagen injections around the neck of the bladder may also be used when surgery is not ideal.
  2. Topical vaginal estrogen may be recommended for peri-menopausal or post-menopausal women with vaginal atrophy and stress incontinence.
  3. Pessary: A pessary, a stiff ring inserted into the vagina to push up against the wall of the urethra and the vagina, may be applied to reposition the urethra and reduce stress leakage.
  4. Catheterization: This treatment is used in women who are incontinent because the bladder never empties fully (overflow incontinence) or when the bladder cannot empty completely because of a spinal cord injury, past surgery or poor muscle tone.
  5. Biofeedback: The therapist puts an electrical patch over the bladder and urethral muscles, uses a wire to connect the patch to a TV screen where the contraction of these muscles is monitored, then with this information uses electrical stimulation and pelvic floor exercises to control stress incontinence.

As a last resort and depending on the severity of the stress incontinence, the urologist may opt for surgery. Surgery for stress incontinence is the most effective treatment for women who have not been helped by other treatments. Common surgical procedures are anterior vaginal wall repair surgery, colposuspension, surgical tape procedure and laparoscopic (keyhole) surgery. If you have urinary incontinence, speak with your doctor about whether surgery will help you and what type of surgery is perfect for you.

At Advanced Urology Institute, we have a solid track record of helping men and women plagued with urinary incontinence put their lives back on track. We have state-of-the-art facilities and skilled, board-certified urologists to assess, diagnose and treat any type of incontinence. For further help with urological disorders, visit the site, Advanced Urology Institute.

2 Kinds of Incontinence

Urinary incontinence (UI) is the involuntary loss or leakage of urine because of faulty bladder control. Due to pregnancy, structure of the female urinary tract and menopause, women experience urinary incontinence twice as often as men. And according to various studies, 25-45 percent of women in the United States experience some degree of urinary incontinence. In women between 20 and 39 years old, 7-37 percent report some degree of incontinence, while 9-39 percent of women older than 60 report daily incontinence.

Two types of incontinence

Urinary incontinence may result from functional abnormalities in the lower urinary tract or may be caused by other illnesses. There are two types of incontinence, stress incontinence and urge incontinence. Stress urinary incontinence is the involuntary urine leakage from effort, exertion, sneezing or coughing. Stress incontinence occurs because of weakened pelvic floor muscles. It is the most common type of urinary incontinence in young women and the second most common one in older women. This type of incontinence will lead to urine leaks when performing any activity that increases strain on the weakened pelvic floor muscles, such as walking, jumping, exercise, bending, stretching, sneezing, coughing, lifting, and even sex. The amount of leaked urine varies from a few drops up to a tablespoon or more, depending on the severity of the condition.

Urge urinary incontinence is the involuntary urine leakage that is accompanied or immediately preceded by urgency (an abrupt or sudden compelling desire to pass urine that is very difficult to defer). Urge incontinence occurs because of overactivity of the detrusor muscle, with its hallmark being a sudden, overwhelming urge to pass urine, accompanied by leakage or loss of urine. Nighttime urination and frequent urination often occur with urge incontinence. For some women with urge incontinence, even changing a sitting position or hearing running water can trigger bladder contractions and result in urine loss. While urge incontinence may occur in anyone of any age, it is common among older women. Actually, just 9 percent of women ages 40-44 suffer from urge incontinence while at least 31 percent of women 75 and older have the condition.

Seek immediate help

Involuntary leakage of urine is more than a health concern. It affects women on a psychological, social and emotional level. Women with urinary incontinence may avoid certain situations or places for fear of having a leakage accident. In fact, for a significant number of women, the incontinence may be so serious that it calls for changing clothes and avoiding certain tasks and exercises. Some women also may experience mixed incontinence, a condition where urge incontinence and stress incontinence occur at the same time. Therefore, it is important for women experiencing urine leakage of any kind to seek help from a urologist to determine whether they are suffering from urge incontinence, stress incontinence, mixed incontinence or another issue.

At Advanced Urology Institute, we understand that there are a significant number of women living with a lot worse problems than they should. We provide top-notch facilities and experienced board-certified urologists to help such women. For more information, visit the site, Advanced Urology Institute.