Dr. Jeffrey Rosenblum, M.D.

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Publications: Philadelphia Inquirer

Urinary Incontinence
A Common Issue For Both Men And Women
August 4, 2005

By Jeffrey Lee Rosenblum, MD.
Urologic Surgeon

Urinary incontinence is a pervasive malady. Approximately 15 million people in the United States suffer from this disorder. In the general population, aged 15 to 64 years old, up to 30 percent of women and 5 percent of men are affected. At least 50 percent of nursing home residents have urinary incontinence ó 70 percent of them women. An estimated $10 billion a year is spent on the management and treatment of urinary incontinence.

There are several types of urinary incontinence. These include stress, urge, mixed and overflow.

Stress incontinence is urine loss during physical activity that increases
abdominal pressure (e.g. coughing, laughing, sneezing, running). Stress
Incontinence may be seen in women as they get older and the muscular tissue supporting the bladder weakens. Childbirth and pelvic surgeries may cause a laxity in this area as well. In men, stress incontinence can occur after prostate surgery where the muscular tissue (called the sphincter) in the area of the prostate gland loses its ability to shut off the flow of urine.

Urge Incontinence is the sudden loss of urine with an urgent need to void.
This may be secondary to a generalized condition known as overactive bladder (OAB). Patients with neurologic or brain disorders such as stroke, Parkinsonís disease or spinal cord injury may manifest with involuntary bladder spasms or contractions as well. Urinary urgency and urge incontinence can also be seen when the bladder Is Irritated from stones or tumors.

Mixed incontinence is categorized when a patient exhibits both stress and urge incontinence. 

Overflow incontinence occurs when the bladder does not empty completely and urine dribbles out. This is analogous to tipping over a full pitcher.
Prostate enlargement (BPH) in men may cause a blockage of the bladder resulting in this scenario. Bladder muscle or nerve damage can result in a floppy bladder with overflow as well.

Urinary incontinence may be transient in nature, as opposed to permanent. Some common causes of transient incontinence are confusion, infection, menopause, depression, restricted mobility and constipation. Various medications may be the culprit of transient urinary incontinence. These include diuretics (water pills) and sedatives. Alcohol may exacerbate incontinence by causing an increased volume of urine production, as well as sedation.

As with any medical condition, the main stay of diagnosing and treating urinary incontinence centers around the history, the physical exam, urine and blood tests, and specialized investigations.

The urologist is the specialist most adept at evaluating arid treating urinary incontinence. Some of the specialized tests that can facilitate the correct diagnosis and subsequent treatment include: cystoscopy (looking inside the bladder with a small telescope); urodynamic studies (measuring the capacity and function of the bladder); post-void residuals (measuring the amount of urine left in the bladder after voiding) voiding diaries (the patient records how much and how frequently they urinate); and ultrasound and x-ray evaluation of the kidneys and bladder.

Treatment for urinary incontinence depends on the specific type of incontinence, symptoms and patient clinical parameters. Stress incontinence can be treated through various tissue supporting procedures. One of these is a minimally invasive procedure called the Tension-Free Vaginal Tape (TVT, Gynecare, a Johnson & Johnson Company). In this treatment a ribbon of synthetic mesh Is placed underneath the urethra (the tube that urine exits the body through) in women through a small puncture. This reinforces the ligaments and tissues that support the urethra preventing leakage with movement. Excellent results are obtained.

Injectable materials such as collagen (a naturally occurring protein) are used to bulk up the urethra in cases where the closure pressure is low. This is used in both men and women. The material is injected below the lining of the urethra through a small telescope. However, complete dryness is rare and results have not been long-lasting.

A surgically implantable device called the artificial urinary sphincter (American Medical Systems, Minnetonka, Minn.) is used when there is moderate to severe incontinence from a damaged sphincter muscle. The device consists of a cuff which fits around the urethra or bladder neck. A reservoir filled with fluid is placed underneath the abdominal muscles. A pump is placed in the scrotum in men or in the labia in women. The patient squeezes the pump when he or she wants to void. The cuff opens for a few minutes allowing urination. It then closes afterwards to keep the patient dry. Dryness rates have been excellent.

Medication treatment for urinary incontinence has recently witnessed a new generation of products. Many of these medications inhibit the bladderís nerve receptors to slow the bladder down. Some of these pills are quite selective for certain bladder receptors. Side effects can be dry mouth and constipation.

For patients with urinary urgency and urge incontinence not responding to medication, an implantable device called InterStim (Medtronic, Minneapolis,
Minn.) is available. It consists of a small pacemaker that is placed under the skin. An attached wire is then threaded under the skin into the area of a sacral nerve in the patientís back. InterStim emits an impulse that slows down the bladders contractions resulting in decreased urgency incontinence and frequency.

In cases of overflow incontinence from prostate enlargement, many treatments are available to shrink down or loosen up the prostate. Surgical procedures to scrape out the inside of the prostate have been very common.

Additionally, minimally invasive in-office treatments are now available. One of these is the TUNA (transurethral needle ablation of the prostate, Medtronic, Minneapolis, Minn.) procedure which uses radio frequency energy to relieve bladder obstruction.

To find out more about urinary Incontinence or other urologic issues, or to schedule an appointment, contact Dr. Rosenblum at 610-594-5444 or 877-MD-URINE (toll-free) or visit www.rosenblumurology.com.


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