Symptoms of dysuria often occur in old age in women, but can sometimes bother young girls.
Urinary incontinence occurs due to the pathological inability of the bladder sphincter to contract, as well as under the influence of various stressful situations. The conservative method of solving the problem in this case is not effective, so doctors prescribe a radical method to patients.
Preoperative studies
Doctors identify several stages of examination before making a decision on intervention and preparation of the patient:
- General history taking, identifying the presence of chronic diseases. Ailments such as diabetes, kidney inflammation, and urolithiasis greatly affect the process of urination. The number and duration of labor, previous stroke, surgery for adenoma, etc. also play an important role.
- Vaginal examination in women. It allows you to identify the presence of scars on the genitals, check the degree of uterine prolapse, and assess the condition of the urethra and bladder neck.
- Ultrasound of the pelvic organs. It allows you to determine the amount of urine in the bladder after urination and some other parameters.
- Urodynamic study. It is usually carried out by the patient himself. He may be asked to keep a diary in which he will record the amount of fluid he drinks, the frequency of urination, and the volume of urine excreted. Some doctors deny such studies clinical significance and limit themselves to the previous three methods.
Psychological setting to distract from the desire to urinate
Use of special simulators. For training, many compact devices have been created that allow you to strengthen the pelvic floor muscles with maximum efficiency and perform all the necessary exercises for urinary incontinence in women. One of these simulators is the PelvicToner. This device, based on the properties of a spring, allows you to gradually and correctly increase the load on the intimate muscles, strengthening them. It is easy to use and care, and its effect is confirmed by clinical trials.
Psychological training. If you have a strong urge to urinate, you can try to distract yourself from the thought of it. Everyone has their own ways: think about plans for the day, read an interesting book, take a nap. The main task is to make the brain forget about going to the toilet, at least for a short period.
Indications for surgery
Normally, urine flows from the bladder into the urethra - the urethra. This process is controlled by the sphincter - the muscle that opens and closes the organ, as well as by the muscles of the urethra and its special position. When muscles weaken or the angle of attachment of the urethra to the bladder changes, urinary incontinence develops. This may be a consequence of childbirth, injury, surgery, age-related and hormonal changes.
Surgical intervention is indicated in the following cases:
Stress urinary incontinence in women associated with weakening of the pelvic floor muscles. If the disease is mild, the doctor may recommend doing special exercises or taking certain medications, in particular antidepressants. However, the effect of all these measures is usually insignificant, so surgery or the installation of a pessary (strengthening device) is recommended.- Postoperative urinary incontinence in men, insensitive to conservative therapy. Such complications are especially common after surgical interventions performed on the prostate gland.
- Conditions that increase the likelihood of recurrent urinary incontinence. These include obesity, diabetes, as well as constant heavy physical activity and sports.
TVT and TVT-O package
To carry out the procedure, the “TVT package” is used.
The TVT package consists of a polypropylene tape connected to special punching needles located in a case. The width of the tape is about 1 cm, length 40 cm. A steel guide probe and a steel pusher are also used for the procedure.
Rice. A – steel pusher, B – polypropylene mesh, C – steel guide probe, D – polypropylene mesh with needles.
The package for the TVT-O procedure consists of a polypropylene tape connected to needles in covers and a steel guide.
Set for TVT-O.
Types of operations
Although the nature of the intervention will differ significantly between men and women, there are some techniques that can be effective regardless of the patient's gender. In particular, these include sling surgery and bladder sphincter implantation.
Other types of interventions are relevant only for women. They are built on the contact of the bladder with the organs of the reproductive system and use the latter to fix or support the urethra.
Sling surgery
This type of intervention is indicated for stress urinary incontinence of II-III degree with a hypermobile urethra or weakness of its internal sphincter. It comes down to suspending the urethra and fixing it in the required position using a prosthesis.
During the operation, a loop made of prolene is used. Some modifications use slings - support devices consisting of the patient's own tissue or donor tissue. In the latter case, a flap of tissue from the fascia with a length of 2 to 10 cm is first excised. The donor sling is prepared before the operation - kept for some time in a special solution.
Sling surgery for stress urinary incontinence in women
Slings used for men have some differences. They should be easily adjustable and in no case should they tighten the urethra. Argus brand products have proven themselves to be the best, causing minimal complications.
The operation, as a rule, does not require abdominal incisions; vaginal access is used. The doctor excises the tissue of the anterior vaginal wall and inserts a synthetic loop. In men, the incision is made in the scrotum area. The loop is fixed with a non-absorbable thread. Its other end is sutured to the connective tissue membrane of the rectus abdominis muscle. To do this, a puncture is made in the abdominal cavity. As a result, the urethra is suspended in the required position, and its walls are strengthened. This prevents involuntary urination. The effectiveness of the operation, according to the Israeli doctor T.V. Baevsky, ranges from 70% to 95%.
The recovery period takes place on average within two weeks. Discharge can be made on the day of surgery or the next. In some clinics and hospitals, hospitalization takes 3 days. A catheter may be inserted into the ureter to make urination easier at first. After discharge, it is better to stop driving and playing sports until complete healing.
Anterior plastic surgery (colporrhaphy)
The operation is performed on women with stress urinary incontinence. Its essence is to “tighten” the vaginal tissue, as a result of which the urethra stops sagging. The operation can be performed intravaginally, abdominally (with access through the abdominal cavity). The first option is the most favorable because it is the most physiological. The choice of method depends on the patient’s medical history and condition. Abdominal access can be achieved using a traditional incision or laparoscopically (through small punctures).
The doctor dissects the mucous membranes of the anterior wall of the vagina and separates them from the muscle tissue of the organ. The latter are sutured by applying non-absorbable sutures. As a result, the urethra receives support, and urine ceases to be released from it involuntarily. This operation allows you to maintain the elasticity of the vaginal walls, in contrast to the sling operation, and makes natural childbirth possible later.
After the intervention, it is important to maintain intimate hygiene and avoid constipation. The recovery period lasts up to 2 months. The main disadvantages of the intervention include a high risk of scar formation.
Colposuspension according to Birch
Colposuspension involves the use of vaginal ligaments to which the urethra is attached and fixed. The operation is characterized by high efficiency and low risk of complications. Also, due to its prolonged action, colposuspension can be recommended for women with an increased risk of recurrent stress urinary incontinence.
One of the disadvantages of the operation is that it is abdominal; all manipulations are performed through an incision in the abdominal cavity or laparoscopically. General anesthesia is used. This determines a rather long recovery period.
Before starting the intervention, the patient should lie on her back with her legs spread to the side. A catheter with a balloon is inserted into the ureter. An incision is made in the lower abdomen, transverse or longitudinal. With laparoscopic access, several punctures are made into which tubes for instruments are inserted. The doctor carefully bends back the subcutaneous tissue and blood vessels until the vaginal wall is exposed. Using a balloon, a sterile solution is injected into the bladder during surgery, and thus the organ is better visualized. This area is not touched with a scalpel, since it is important to preserve the integrity of the muscular layer (detrusor).
The vagina is separated from the bladder. In parallel, the process is controlled by fingers inserted into the vagina. Tight adhesions are carefully dissected to ensure bladder mobility. Sutures are placed on the vaginal fascia (connective tissue), leaving the ends of the threads free. The surgeon pulls the organ behind them, and the assistant ties them.
A drainage tube remains in the wound and a catheter is left in the bladder for 5 days. At this time, bed rest is indicated. With laparoscopy, this period can be significantly reduced. As a result, difficulties with urination are possible, which can also be solved by placing a catheter.
Implantation of an artificial bladder sphincter
The operation is performed primarily on men. There is information about the possibility of using the design for women, but in fact this happens extremely rarely. The essence of the intervention is the patient’s ability to independently control the diameter of the urethral lumen and, accordingly, urination.
During the operation, the bulbous part of the urethra is isolated - that part of it that goes from the sphincter to the beginning of the penis. A cuff is put on it. After this, the reservoir is implanted into the space in front of the bladder. A pump is installed in the scrotum, which will regulate the pressure in the cuff and, accordingly, open or close the lumen of the urethra.
The patient gets the opportunity to control his own urination. The cuff is filled with fluid that accumulates in a reservoir. After pressing the pump, the valve opens and it flows from the urethra. As a result, the patient can urinate whenever it is convenient for him.
Prevention of urinary incontinence
Maintain the body's water balance. To do this, you need to drink 1.5-2 liters of still water per day. Drinking too much and not drinking enough can be harmful to your health. Try to create your own urination routine. It is quite possible to train yourself to empty your bladder at a certain time. For example, in the morning before getting ready for work, during the lunch break, immediately upon arriving home, visit the toilet and consolidate this habit.
Fight excess weight (on your own or with the help of a specialist) Give up bad habits. Reduce consumption of caffeine-containing foods and salty foods. Fight constipation, if any. To do this, you can eat foods rich in fiber (vegetables, fruits, especially prunes, figs), drink enough liquid, and drink half a glass of kefir at night.
Urinary incontinence is a very common problem among women. Without treatment, urinary problems are unlikely to go away on their own. To determine the type of incontinence, you need to undergo an examination, including filling out a questionnaire and keeping a urination diary. Stress incontinence is treated with surgery, and urge incontinence is treated with medication.
Choosing the optimal technology
Recent evidence suggests that the use of a sling for female stress urinary incontinence is a treatment option that provides better results. Even after 10 years, patients note a high quality of life, thanks to the almost complete absence of leaks.
For men, the best technique, according to doctors, is the installation of an artificial sphincter. This operation allows you to solve problems with incontinence of almost any origin. A sling can only help with mild illness.
Stress urinary incontinence
Risk factors:
- Caucasian race heredity (if there is a disease in close relatives or cases of enuresis in childhood, the risk of incontinence is greater);
- obesity (especially in combination with diabetes);
- neurological diseases (stroke, heart attack, parkinsonism, spinal injuries);
- urinary tract infection; digestive disorders; taking certain medications;
- anemia.
Stress urinary incontinence in women causes a lot of trouble. Refusal to play sports, fear of leaking urine in public, constant nervous tension have a negative impact on health. Therefore, it is important not to be embarrassed or hush up this topic, but to consult a doctor in a timely manner.
Cost of the operation
Some types of intervention can be provided free of charge as part of a high-tech assistance program.
To do this, you need to apply for a quota and, possibly, wait your turn for the operation. These methods include:
- Sling operations.
- Interventions with abdominal cavity and laparoscopic access.
- Treatment of male incontinence, including installation of sphincter prostheses. Note. In this case, you may have to pay for the prosthesis yourself.
If desired, the patient can go to a private clinic, where medical care will be provided at a time convenient for him. The operation to install a sling will cost 80,000 – 100,000 rubles. The price can be significantly increased when using the latest generation devices. Vaginal plastic surgery can cost from 50,000 to 200,000 rubles. Colposuspension in private clinics is carried out mainly by laparoscopic access. The average cost is 150,000 rubles. The most expensive type of intervention will be bladder sphincter implantation. The price can reach up to 500,000 rubles.
Purpose of surgical treatment
The cause of bladder prolapse is the inability of the musculo-ligamentous apparatus to perform the functions of supporting the organ in its anatomical position. Therefore, the main purpose of the operation is to correct muscle tissue defects by forming new supporting fascia and restoring the physiological functions of the bladder and the walls of the vaginal canal.
Surgery for cystocele is aimed at reducing the occurrence of similar defects in the future, as well as eliminating difficulties with urination and returning the patient to a normal sexual life.
To eliminate the disease surgically, modern medicine uses the least traumatic methods that are safe for the patient’s health.
Reviews
The problem of urinary incontinence is extremely delicate for patients. Many people do not dare to see a doctor for quite a long time. This is especially true for women of retirement age. They prefer to use pads rather than raise the issue of urinary incontinence. Some suffer for years, during which time their self-esteem decreases and their ability to socialize worsens.
In their reviews, patients note that their quality of life has increased dramatically after the operation. The majority are unanimous in the opinion that the intervention itself and several months of the recovery period are definitely worth going through in order to finally say goodbye to the disease.
According to statistics, only a third of patients with urinary incontinence seek medical help. However, the more advanced the disease, the more difficult it is to cure. Therefore, urologists urge you not to be ashamed of your problem, but to take all measures to solve it together with qualified specialists.
Iatrogenic urinary incontinence
Some drugs have urinary disturbances in their list of side effects: adrenergic agonists (pseudoephedrine) can cause urinary retention followed by incontinence and are used to treat bronchial diseases; all diuretics; colchicine (to treat gout); some drugs with estrogens;
sedatives and antidepressants After stopping taking these medications, the unpleasant symptoms go away on their own. Other types of incontinence Rarer causes of urine loss are usually associated with organic pathology. This can be damage to the brain and spinal cord as a result of tumor processes, injuries, strokes, multiple sclerosis.
Causes
Stress can cause incontinence. At the same time, pressure appears inside the peritoneum. This can be caused by: fear, sexual intercourse and physical stress. Genetic predisposition can also be a reason.
An urgent state is characterized in a woman by an unexpected feeling of a strong desire to urinate, and the ability to react is completely absent. A characteristic feature of this situation is that it occurs with a small amount of urine in the bladder.
The mixed type includes symptoms of the two previous types. This creates a vicious circle: the occurrence of an anomaly leads to stress, and stressful conditions are the main cause of incontinence.
Preparatory stages
Before each operation, there are stages of preparation that must be performed in the hospital.
- The first thing you need to do is get advice from the following doctors: therapist, urologist, gynecologist and anesthesiologist. If the doctor discovers an inflammatory disease, then it must be treated before surgery. Each specialist gives the woman his own recommendations.
- After being admitted to the hospital, it is necessary to pass all the tests prescribed by the doctor and undergo an examination to assess the patient’s condition.
- Consultation with an anesthesiologist and preparatory appointments with a specialist.
- The day before, a bowel cleansing procedure is performed. Giving an enema or taking laxatives.
- Shaving the external genitalia and pubic area.
- If the operation is scheduled for the morning of the next day, then food and water intake must be stopped at 6 pm.
