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Frequently Asked Questions

DO I HAVE URINARY INCONTINENCE?

Have you experienced any of the most common symptoms of Urinary Incontinence?

What is Stress Urinary Incontinence?

Stress Urinary Incontinence is the involuntary loss of urine during physical activities, like laughing, jumping, sneezing or lifting heavy objects. It’s the most common form of urinary incontinence.

What are some of the symptoms of Stress Urinary Incontinence, and how is it caused?

Stress Urinary Incontinence is the involuntary loss of urine during physical activity, which may include but is not limited to: coughing, laughing or lifting. Incontinence occurs when the muscles that support the urethra (the tube that carries urine outof the body) are weakened or damaged. This can happen as a result of childbirth, trauma, obesity, family history, hormone changes and many other reasons.

My doctor says I have Stress Urinary Incontinence. Are there different types?

Yes, there are different types. One type is called hypermobility, “hyper” means too much and "mobility" refers to movement, which can result from childbirth, previous pelvic surgery or hormonal changes. Hypermobility occurs when the normal pelvic floor muscles can no longer provide the necessary support to the urethra. This may lead to the urethra dropping when any downward pressure is applied, resulting in involuntary leakage. Another type is called intrinsic sphincter deficiency, also sometimes referred to as ISD. This refers to the weakening of the urethral sphincter muscles or closing mechanism. As a result, the sphincter does not function normally regardless of the position of the bladder neck or urethra.

What are some treatment options?

Many times, conservative treatment options for Stress Urinary Incontinence are used initially. Some of those treatment options include behavioral modification — such as decreasing fluid intake, timed voiding and eliminating caffeine, or pelvic floor muscle training such as kegel exercises to strengthen the pelvic floor and sphincter muscles. These types of treatments may or may not improve symptoms. When symptoms are more severe, or conservative options aren’t working, bulking agent injections or surgery may be an option.

Stress Urinary Incontinence can be treated in several ways, depending on the exact nature of the incontinence and its severity. As disease state and anatomy differ for each patient, outcomes may vary. Consult a specialist for all available treatment options.

Minimally Invasive Treatment: Mid-Urethral Sling

What is a mid-urethral sling system?

A mid-urethral sling system is designed to provide a hammock of support under the urethra to prevent it from dropping during physical activity.

What are the types of sling options?

Many sling options have been developed, the difference being how the mesh material is placed under the urethra. As disease state and anatomy differ for each patient, as well as the type of Stress Urinary Incontinence, consult a specialist for all available treatment options.

How do I know if a sling is a good option for me?

This is a decision that should be made by you in consultation with a specialist. You should have the opportunity to discuss with your specialist all of your treatment options, and then decide which treatment plan is most appropriate for your specific medical situation.

How will my surgery be performed if I elect to have a sling?

A minimally invasive sling procedure is estimated to take between 30 and 45 minutes; this estimate can vary for many reasons. Your specialist will discuss the type of anesthesia with you, the specific procedure steps, and should answer all your questions. Mid-urethral sling procedures are frequently outpatient procedures, in which case, most patients return home the same day.

What are the potential risks and complications of surgery?

As with most surgical procedures, there are potential risks and complications associated with SUI mid-urethral sling surgery. Your specialist can further explain your specific risks based on your medical history and surgical approach used.

Please consult your physician to discuss the associated risk and complications for the specific surgical material you receive. Below is a list of potential adverse events for Boston Scientific’s mid-urethral sling surgical material. The following adverse events and known risks have been reported due to suburethral (beneath the urethra) mesh sling placement, any of which may be ongoing, but are not limited to: Abscess (swollen area within the body tissue, containing a buildup of pus), Allergic reaction to the implant, Apareunia (inability to perform sexual intercourse), Bleeding from the vagina, Hematoma formation (bruising), Complete failure of the procedure/failure to resolve a patient’s stress urinary incontinence, Dehiscence of vaginal incision (opening of the incision after surgery), De novo detrusor instability (involuntary contraction of the bladder wall leading to an urge to urinate), Dyspareunia (pain during sexual intercourse), Edema and erythema at the surgical site (swelling and redness), Fistula formation (a hole/passage that develops through the wall of the organs) that may be acute or chronic, Foreign body reaction (body’s response to the implant) that may be acute or chronic, Infection, Inflammation that may be acute or chronic (redness, heat, pain or swelling at the surgical site as a result of the surgery), Irritation (redness or pain) at surgical site, Leg weakness (muscle weakness), Mesh contracture (mesh shrinkage), Erosion into the following organs: urethra, bladder, or other surrounding tissues and exposure/extrusion into the vagina (when the mesh goes through the vagina into other organs or surrounding tissue), Pain or discomfort to the patient’s partner during intercourse, Pain/Ongoing Pain/Severe/Chronic Pain in the pelvis, vagina, groin/thigh, and suprapubic area that may be acute or chronic (pain or ongoing pain just above the pubic bone, pelvis, vagina, groin/thigh area that may be severe and could last for a long time), Pain with intercourse that may not resolve, Perforation or laceration of vessels, nerves, bladder, urethra or bowel (a hole in or damage to these or other tissues that may happen during placement), Scarring, scar contracture (tightening of the scar), Stone formation (as a result of mesh erosion/exposure/extrusion in the urethra or bladder where the mesh is exposed to urine, mineral deposits may form along the mesh, also known as stones), Tissue contracture (tightening of the tissue), Voiding dysfunction: incontinence, temporary or permanent lower urinary tract obstruction, difficulty urinating, pain with urination, overactive bladder, and retention (involuntary leakage of urine or reduced or complete inability to empty the bladder from the mesh being implanted too tightly beneath the urethra). The following additional adverse events have been reported for the Solyx SIS System: Dysuria (painful/difficult urination), Hematuria (blood in the urine). The occurrence of these events may require surgical intervention and possible removal of the entire mesh. In some instances, these events may be permanent after surgery or other treatments. Removal of mesh or correction of mesh-related complications may involve multiple surgeries. Complete removal of mesh may not be possible and additional surgeries may not always fully correct the complications.

Will a mid-urethral sling cure my incontinence symptoms with 100% certainty?

There is no surgery for incontinence that has a 100% cure rate, but mid-urethral slings for bladder leakage have been studied since the mid-1990s and have shown to have high success rates of 80-95%.1-5 As with any procedure, some patients will have success while others will not. It is difficult to estimate your specific results. Your physician will explain all of your options and determine with you which treatment plan is most appropriate for your specific medical situation. Your physician will consider a number of factors to determine the likelihood of recurrence in your situation. The most appropriate treatment plan for you will be determined by taking many of these factors into consideration

What can I expect during recovery?

Every patient’s recovery experience is unique, and you should consult your specialist as to what he or she expects in your individual case. As with any surgery, it is expected that you feel some soreness but most patients return to normal activity after a short period of time. Please consult with your surgeon on specific activities to avoid during recovery to achieve optimal outcomes. Before you are discharged from the hospital, you may be given a prescription for an antibiotic and/or pain medication to relieve any discomfort you may experience. You will be instructed on how to care for your incision area. At the discretion of your physician, most patients resume moderate activities within 2 to 4 weeks, with no strenuous activity for up to 6 weeks. Talk with your specialist about post-procedure complications and when to notify him or her of a potential concern.

When will I stop leaking?

Most women see results right after the procedure. Talk with your specialist about what you should expect. 

Minimally Invasive Treatment: Injectable Bulking Agent

How does an injectable bulking agent work?

Injectable bulking agents are used to bulk or “fill out” the tissues surrounding the urethra to provide additional support during physical activity in order to prevent or minimize urine leakage caused by Stress Urinary Incontinence.

How do I know if an injectable bulking agent is a good option for me?

This is a decision that should be made by you in consultation with your physician. You should have the opportunity to discuss with your physician all of your treatment options, and then which treatment plan is most appropriate for your specific medical situation.

What can I expect during my procedure? 

The procedure will take place in a doctor’s office, an outpatient surgery center or in an operating room. The procedure takes approximately 15 to 20 minutes. Your doctor will determine what type of anesthesia is best for you.

During the procedure, a needle is placed into the urethra using a cystoscope and the material is injected into the tissues surrounding your urethra providing a bulking effect. The doctor removes the needle and the procedure is completed. After the procedure, you will stay in the office or recovery room until you are able to pass urine on your own, usually within a few hours.

Your doctor will talk to you so you know what to expect from your treatment.

How long do the benefits of injectable urethral bulking last?

Studies show that effects of the treatment can last between one and three years.

Can I go back to my normal activity after I go home?

Your physician will give you specific instructions regarding your activity level after your procedure. Most people return to normal activity within one to two days.

What are the potential risks and complications of injectable urethral bulking?

As with most surgical procedures, there are potential risks and complications associated with injectable urethral bulking. Your physician can further explain your specific risks based on your medical history and surgical approach used. Some potential adverse reactions include:

  • Urinary retention
  • Urinary tract infections
  • Urge incontinence
  • Micturition urgency

What can I expect during recovery?

Your physician will give you specific instructions regarding your activity level after your procedure. Most people return to normal activity within one to two days.

When will I stop leaking?

Most women see results right after the procedure. Talk with your physician about what you should expect. 

References
1. Primus G. One year follow-up on the SPARC sling system for the treatment of female urodynamic stress incontinence. Int J Urol. 2006 Nov;13(11):1410-4.
2. Andonian S, Chen T, St-Denis B, et al. Randomized clinical trial comparing suprapubic arch sling (SPARC) nd tension-free vaginal tape (TVT): one-year results. Eur Urol. 2005 Apr;47(4):537-41.
3. Dalpiaz O, Primus G, Schips L. SPARC sling system for treatment of female stress urinary incontinence in the elderly. Eur Urol. 2006 Oct;50(4);826-30.
4. Davila GW, Johnson JD, Serels S. Multicenter experience with the Monarc transobturator sling system to treat stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2006 Sep;17(5):460-5.
5. Tseng LH, Wang AC, Lin YH, et al. Randomized comparison of suprapubic arc sling procedure vs tension-free vaginal taping for stress incontinent women. Int Urogynecol J Pelvic Floor Dysfunct. 2005 May-Jun;16(3):230-5.

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