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U.S. News and World Report: America's Best Hospitals, Urology, 2012-13

 

Creating Options for Incontinent Women

UW Health urology researcherSeveral studies have documented the negative impact Urinary Incontinence has on a woman's quality of life, with higher depression and anxiety scores routinely noted.

 

The resources available from UW Health Urology allow for accurate diagnosis and the wide breadth of treatment options available allow for the creation of an individualized plan for each patient.

 

Diagnosis for Chronic Incontinence

 

Chronic incontinence diagnosis begins with a detailed medical history and physical examination. Simple tools such as voiding diaries and bladder scanning can be employed. Finally, the UW Bladder Clinic has a state of-the-art video-urodynamics suite, where complex assessment of bladder storage and emptying ability can be performed.

 

The strength of UW Health's urology program lies in its ability to accurately diagnosis the origins of a patient's incontinence before initiating a treatment plan and then to tailor that plan to the individual patient.

 

All currently available treatment options for stress incontinence are offered. UW Health urologists work with a physical therapist trained in female pelvic floor disorders to design an individualized treatment plan which might involve simple exercise, biofeedback and behavioral therapy.

 

For some patients, an office-based procedure involving the injection of collagen, or other material, into the walls of the urethra to add bulk, is the treatment of choice. For some patients, surgery is the better option. A vaginal sling, the most commonly performed surgery, can create a hammock of support to prevent stress urinary incontinence.

 

The UW Health urologists offer retropubic, transobturator and single-incision midurethral slings for various types of incontinence, as well as pubovaginal slings which can address more complicated or refractory forms of incontinence.

 

Many patients undergoing incontinence procedures alone return to normal activities in one to two weeks.

 

Urgency and Urge Incontinence Therapies

 

Urgency and urge incontinence can also be addressed with pelvic floor physical therapy. However, for those patients who don't find satisfactory relief, a variety of medications are available which are designed to inhibit the contractions of an overactive bladder.

 

For patients whose problems don't respond sufficiently to medication, sacral neuromodulation can offer substantial relief. This therapy involves placing a small nerve stimulator, about the size of a stopwatch, beneath the skin of the lower back with wires leading to the sacral nerve in the lower back.

 

The device acts as a pacemaker for the bladder and serves to offset hyperactive nerve activity around the bladder. The device is approved for refractory overactive bladder and idiopathic urinary retention and research at the University of Wisconsin-Madison is ongoing to look at novel applications of this therapy.

 

Experimental Therapies for Incontinence

 

Finally, there are several experimental therapies available, the most prominent of which is Botox®. Botox® is injected into the bladder muscle, paralyzing the overactive muscles and thereby reducing incontinence. It has been found to be very effective in patients whose overactive bladder is related to nervous system injury or damage and it is being actively investigated for patients with idiopathic overactive bladder.

 

Prevalence of Female Pelvic Floor Disorders

 

According to a study published in 2008 in the Journal of the American Medical Association, female pelvic floor disorders affect close to 24 percent of U.S. women. The incidence doubles to 40 percent for women over 60 years and 50 percent for women over 80 years.

 

An estimated 1 in 10 women will require surgery for a pelvic floor disorder, the most common of which is incontinence. But incontinence is not inevitable with age. It is treatable and often curable at all ages.

 

Because incontinence is such a common problem, with potentially severe detrimental effects on quality of life, the UW Department of Urology has created the Bladder Clinic to address these issues. Call (608) 263-4757 for more information.