Urinary Incontinence Treatment

What Kind of a Treatment is Administered for Urinary Incontinency?

Our treatment principles is to carry out a careful inquiry about the complaints of our patients and to detect the prolapse or the fundamental problem that leads to this complaint. Many women might consider the inability to hold their urine as normal. However, it must be known that urinary incontinence is not a disease, it might have many reasons.

For example, it might confront us as the first finding of Parkinson and Alzheimer diseases. The key to success in the treatment of urinary incontinence is to research the reason thoroughly and start the treatment after that. All assessments concerning the patients, who are planned to undergo surgery, are carried out with advanced technology in our clinic.

The most common two reasons of urinary incontinence: stress incontinence and urge incontinence are distinguished in that stage. Urge incontinence is usually treated with medication and physical rehabilitation of pelvic floor muscles. Urge incontinence affects the quality of life of women very adversely. In our clinic, the quality of life of this type of patients is improved in a short very period of time through exercises and drug therapy.

Stress incontinence is incontinence that takes place simultaneously with laughing, coughing, lifting heavy weights, straining which lead to an increase in the intraabdominal pressure. Pelvic organ prolapses cause this type of incontinence. Stress incontinence is treated via exercising of  pelvic floor muscles or surgery. Surgical method called “Tension free vaginal tape” which has been performed on about 1 million people all over the world and which is accepted as the golden standard method by many surgeons, is implemented in our clinic successfully under local anaesthesia. Our success rate is over 95%.

Treatment of our patients with pelvic organ prolapse and incontinence complaints is shalped according to the cause of the problem, severity of the symptoms, strength of the pelvic floor muscles, expectations and sexual activity of the individuals and the general health condition thereof. Surgical treatment of prolapses without excising the uterus is carried out successfully in cases of uterus prolapse.

Abdominal Surgeries

Burch or Marchall Marchetti Kranz operations are performed. These operations are open operations or they can be performed through laparoscopy Burch operation is an operation implemented against stress incontinence (urinary incontinence through coughing or sneezing). It is usually performed together with other operations. Technically, it is bonding of the bladder neck to the ligaments on the anterior wall of the abdomen by entering between the bladder and the pubis through a cut on the anterior wall of the abdomen. This can procedure can also be carried out through laparoscopy.

Vaginal Operations 

TVT, IVS, needle suspension technique, tension-free slings (TFS) (TVT, VS, Safyre etc.). The characteristic of these operations is fixation of a ribbon shaped synthetic material (sling) to the muscles of the anterior wall of the abdomen by making it pass under the urethra. The sling lifts the urethra upwards increasing the intraabdominal pressure. When the intraabdominal pressure of the patient increases, the urethra climbs on the sling, the pressure inside the urethra increases, thus preventing patient from leaking urine.

The most common performed vaginal operations are tension-free vaginal tape (TVT) operations and intravaginal slingplasty (IVS). Tension free operations are minimal invasive methods that eliminate all the disadvantages of traditional methods and break new grounds in incontinence surgery. Tension-free vaginal tape (TVT) is an operation that has gradually come to the foreground in the recent years and has been performed more than 1,000,000 times. Its advantage over traditional surgery is that these operations are performed under local anaesthesia, sling is detected in a position (discovered by making the patient cough) in which the patient does not leak urine and the patient is discharged from the hospital on the same day.  In tension-free sling operations, patients do not face the problem of being unable to void as the sling is detected by making the patient cough and/or with the help of the valsalva manoeuvre. These characteristics of the method reduces the complications of the method. Furthermore, the patient can be discharged from hospital on the same day and long term success rates are over 95%. The only disadvantage of these operations is that they require standard materials worth between 250 and 1000 dollars.

Although these operations seem to be simple, they require a certain period of study. For example, according to the figures of the Ethicon firm, which produces TVT, 4 deaths among 160,000 applications have occurred due to bowel perforation or vascular injury.

Sub-urethral Patch 

It is difficult for laparoscopic Burch to remain in practice as it takes too much time and requires a vertical learning curve in the field of stitching. Disadvantages and success of such retropubic mid-urethral sling procedures such as tension-free vaginal tape or sub-urethral patches have replaced all the other anti-incontinence procedures to a large extent.

Sub-urethral patch has introduced the development and use of transobturator mid-urethral sling procedures and vaginal “kit” procedures for pelvic organ prolapse.

Artificial Urethral Sphincter 

Layers are passed through with an incision through perineum (the area between the scrotum and the rectum) following insertion of an epidural catheter or an urethral catheter under general anaesthesia. The urethra is found. Sphincter of an appropriate size is placed. The water reservoir of this sphincter is placed into the abdomen through a cut in the iliac region and the control pump is placed inside the scrotum.

Later, the cuts are sewn up with stitches properly. Urinary incontinence problem is eliminated in this manner.

Anterior Colporraphy with Kelly’s Plication

This procedure consists of lifting the bladder up with a vaginal operation and placement of a supportive thread to the urethra. It is not used in the treatment of urinary incontinence anymore as the success rate thereof is very low. It is one of the first urinary incontinence operations performed.

It is old fashioned.