Urinary Incontinence
"The surgical option is becoming less invasive and safer, with healing rates reaching 80%, even in patients with previously failed interventions".
DR. FERNANDO RAMÓN DE FATA CHILLÓN
SPECIALIST. UROLOGY DEPARTMENT
Urinary incontinence is the involuntary loss of urine without control of the filling and emptying of the urinary bladder, sometimes accompanied by a strong desire to urinate.
The Clinic has the latest technology for conservative treatment and a high success rate in surgery.
Several types of treatment are possible:
Conservative (exercises to improve bladder muscle tone).
Pharmacological (for urge and stress incontinence).
Surgical, through minimally invasive surgery.
The most effective procedure, about 90%, consists of placing a synthetic mesh under the urethra.
On the other hand, we have a Rehabilitation Service with state-of-the-art equipment such as the wireless device, which provides greater comfort to the user to perform the exercises.
What are the symptoms of urinary incontinence?
The patients' symptomatology is very significant and, with these data, the physician can already establish a first diagnostic approach.
In addition, it may be convenient to carry out a urodynamic study. This test provokes and reproduces the symptoms referred by the patient and in order to obtain a graphic record. In this way it will be possible to know, among other data, the type of incontinence that the patient suffers.
Urinary incontinence: what it is and its treatment (available in spanish)
Do you have any of these symptoms?
You may have urinary incontinence
What are the causes of urinary incontinence?
Urinary incontinence is a pathology that affects both men and women, very much related to age, and is due to multiple causes. It is a pathology that significantly impacts the quality of life of patients.
Age, pregnancy and childbirth, and obesity, among other causes, can produce urinary incontinence in women.
In men, the most frequent cause is stress incontinence as a sequel to surgery.
Depending on the type of incontinence, it can have different causes:
- Stress incontinence, coinciding with physical activity, coughing, sneezing or laughing, which represents 25% of cases.
- Of urgency, it is a loss of urine associated with an uncontrollable desire to urinate, which represents 20% of cases.
- Mixed, in which symptoms of the two previous ones are associated and which is the most frequent type. It is produced by age, pregnancy and childbirth, menopause, functional and cognitive impairment, and other factors such as surgery, obesity, certain types of physical exercise, etc.
What types of urinary incontinence are there?
Continuous or total urinary incontinence, which is the constant loss of urine.
Stress urinary incontinence, in which there is a sudden loss of urine when performing any activity that causes an increase in intra-abdominal pressure (physical exercise, coughing, sneezing, etc.). This type of urinary incontinence is the most common in women, especially those who have had multiple pregnancies and vaginal deliveries and whose bladder, urethra or rectal wall protrudes into the vagina (pelvic prolapse). It can also occur in men with prostate surgery.
Urge-incontinence is characterized by a sudden leakage of urine preceded by an intense desire to urinate. It is usually produced by an increase in the capacity of contraction of the urinary bladder musculature and may be related to neurological diseases and injuries.
Incontinence due to overflow or paradoxical, which occurs in patients with obstructive processes in the lower urinary tract, which determine a chronic urinary retention (incomplete emptying of the bladder) but cause involuntary loss of urine.
How is it diagnosed?
The diagnosis and evaluation of the type and degree of urinary incontinence is made by
- Clinical history and physical examination.
- Voiding diary and evaluation by means of questionnaires (ICIQ-SF).
- Pad test or 24-hour pad test, allows quantification of losses in mild (< 200 cc), moderate (200-500 cc) and severe (> 500 cc), by means of the weight of the pads.
- Analysis of urine and urine culture.
- Flow measurement and measurement of post-voidal residue.
- Urethrocystoscopy: allows to rule out the absence of urethral stricture or sclerosis in the vesico-urethral anastomosis and assess the integrity and function of the external urethral sphincter.
- Urodynamic study (pressure-flow).
How is urinary incontinence treated?
The Clinic has the latest technology for conservative treatment and a high success rate in surgery.
Conservative treatment
The first therapeutic step is the hygienic-dietary measures, behavior modification techniques and muscular rehabilitation of the pelvic floor.
Pharmacological treatment
Medication indicated especially for stress and urge incontinence.
Surgical treatment
Minimally invasive surgery for patients in whom conservative and pharmacological treatments have not been effective.
Due to its effectiveness in nearly 90% of cases, the tension-free transvaginal transobturator (TOT) mesh procedure stands out, which is inserted through a small vaginal incision. It is a tape, usually made of polypropylene. Since it is porous, it is fixed and integrated into the body.
The operation lasts about 25 minutes and is usually performed under epidural anesthesia, although it can also be performed under local anesthesia. It is a simple and very non-invasive intervention, which facilitates the rapid recovery of the patient at home.
Incontinence stops when the mesh is placed, although it is recommended to avoid great efforts during the first month after the intervention.
Sometimes, there is associated pelvic organ prolapse, and laparoscopic or robotic correction (colposacropexy) is performed.
The treatment of incontinence in men can be conservative, in cases of mild incontinence (physiotherapy and rehabilitation of the pelvic floor), although in more severe and disabling cases, surgical treatment will be required.
The following treatments are available:
- Artificial urinary sphincter (severe incontinence due to sphincter deficit).
- Placement of suburethral meshes in mild urinary incotinence.
- Placement of adjustable transobturator system for male stress urinary incontinence, which allows the device to be adapted once implanted, to completely correct urine loss. This device offers the advantages of a minimally invasive treatment, through a single incision, with less morbidity than a sphincter and with a hospital stay of 24 hours.
Where do we treat it?
IN NAVARRE AND MADRID
The Department of Urology
of the Clínica Universidad de Navarra
The Department of Urology of the University of Navarra Clinic offers the patient a medical team, composed of first-rate professionals, and state-of-the-art diagnostic and therapeutic means such as the Da Vinci® robotic surgery.
The Department of Urology possesses the certificate of accreditation of the European Board of Urology, a reinforcement of the excellence of the service at the level of care, teaching and research, which in Spain only three hospital centers possess.
Diseases we treat:
- Prostate Cancer
- Kidney Cancer
- Bladder Cancer
- Testicular Cancer
- Benign prostatic hyperplasia
- Urinary Incontinence
- Renal Lithiasis
- Genitourinary Prolapses
- Pediatric Urology
Why at the Clinica?
- A team of top-level professionals trained in international centers.
- State-of-the-art technology for diagnosis and treatment.
- In 24-48 hours you can start the most appropriate treatment.
