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
What is urinary incontinence?
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 Clínica Universidad de Navarra has the latest technology for conservative treatment and a high success rate for surgical treatment.
There are several types of treatment:
- Conservative (exercises to improve bladder muscle tone).
- Pharmacological (for urge and stress incontinence).
- Surgical, using minimally invasive surgery.
The most effective procedure, around 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 for the user to perform the exercises.
Symptoms of urinary incontinence
Urine leakage during physical exertion, such as coughing, sneezing, laughing, lifting heavy objects or physical exercise (stress urinary incontinence).
Sudden and intense urinary urgency, accompanied by the inability to get to the toilet in time (urge urinary incontinence or overactive bladder).
Constant urine leakage or continuous dribbling, which may indicate chronic urinary retention with overflow (overflow incontinence).
Increased urinary frequency, both during the day and at night.
Sensation of incomplete emptying of the bladder.
Alterations in the quality of life, such as anxiety, social isolation, sleep disturbance, and impairment of sex life.
Do you have any of these symptoms?
If you suspect that you have any of the above symptoms,
you should consult a medical specialist for a diagnosis.
What are the causes of urinary incontinence?
Urinary incontinence is a pathology that affects both men and women, closely related to age, and is due to multiple causes. It is a pathology that has a significant impact on patients' quality of life.
Age, pregnancy, childbirth and obesity, among other causes, can lead to urinary incontinence in women.
In men, the most common cause is stress incontinence as a consequence of surgery.
Depending on the type of incontinence, it can have different causes:
- Stress, coinciding with physical activity, coughing, sneezing or laughing, which accounts for 25% of cases.
- Urgency urinary incontinence, which is a loss of urine associated with an uncontrollable urge to urinate, which accounts for 20% of cases.
- Mixed, in which symptoms of the previous two are associated and which is the most frequent type. It is caused by age, pregnancy and childbirth, menopause, functional and cognitive deterioration, and other factors such as surgical interventions, obesity, certain types of physical exercise, etc.
What types of 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 carrying out 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 in those who have had multiple pregnancies and vaginal births and whose bladder, urethra or rectal wall protrude into the vagina (pelvic prolapse). It may also occur in men who have had prostate surgery.
Urge-incontinence is characterised by the sudden leakage of urine preceded by an intense desire to urinate. It is usually caused by an increase in the contractile capacity of the muscles of the urinary bladder and may be related to neurological diseases and injuries.
Overflow or paradoxical incontinence, which occurs in patients with obstructive processes in the lower urinary tract, resulting in chronic urinary retention (incomplete emptying of the bladder) but causing involuntary urine leakage.
How is urinary incontinence diagnosed?
The diagnosis and assessment of the type and degree of urinary incontinence is made by:
- Clinical history and physical examination
- Voiding diary and assessment by questionnaires (ICIQ-SF)
- Pad test or 24-hour pad test
- Urinalysis and urine culture
- Urine flowmetry and postvoid measurement
- Urethrocystoscopy
- 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.
Our expert urinary incontinence team
