Procedure aids women suffering incontinence

Marvin Dietrich, Gary Newman and David Forest
Special for The Republic
Jan. 16, 2004 12:00 AM


QUESTION: My pelvic floor is sagging, causing me to have incontinence
problems. Are there any new options for women like me?

ANSWER: We were the first in the Valley to perform a new procedure to
secure a sagging pelvic floor. The posterior intravaginal slingplasty
procedure is a new, minimally invasive approach that applies a mesh
tape to the upper part of the vagina. A piece of surgical mesh tape
is threaded at the top of the vagina and through the pelvic side
walls to support the top of the vagina. Then a fibrous-tissue
reaction occurs around the tape, which strengthens and replaces
weakened pelvic ligaments and suspends the top of the vagina in its
normal position.

The procedure, developed and studied in Australia and Europe, has had
success rates reported to be approximately 90 percent.

If pelvic-floor muscles become weakened, these organs are no longer
supported, which can result in incontinence or other symptoms that
may warrant corrective surgery. The posterior IVS can reverse these
symptoms. This is important because half of all women experience
incontinence at some point in their lives and about one-third develop
a regular problem. After age 60, incontinence is twice as common
among women than it is among men.

Another new option is Medtronic InterStim Therapy that helps control
urinary problems through an implanted device. Mild, electrical
impulses are sent to the sacral nerves below the base of the spinal
cord, that control the bladder, sphincter and pelvic-floor muscles.
This "pacemaker for the bladder" is indicated for the treatment of
urinary retention and the symptoms of overactive bladder, including
urge-incontinence and significant symptoms of urgency frequency,
alone or in combination, in patients who have failed or could not
tolerate more conservative treatments.

In fact, this therapy is being considered by the FDA as a potential
treatment for interstitial cystitus when other treatments have
failed. IC is a condition characterized by chronic pain of the
bladder and pelvic region with an urgent need to urinate.

Electrical stimulation through InterStim Therapy is distributed
through a lead implanted adjacent to the sacral nerves. This lead is
connected to a neurotransmitter the size of a stopwatch that is
typically implanted under the skin of the upper buttocks, below the
beltline, or in the abdomen. The electrical stimulation ultimately
strengthens the pelvic floor and bladder muscles.

In clinical studies, InterStim Therapy, which is reversible, has been
shown to successfully treat certain bladder-control problems in many
patients who had failed or could not tolerate other treatments.
InterStim Therapy offers hope for women who have tried medication,
biofeedback and pelvic-floor exercises without symptom relief, but
without undergoing a non-reversible procedure such as bladder
augmentations, removals or urinary diversions.

These and other procedures will be discussed at "Female Bladder
Problems?" a free forum on Feb. 6, that you may want to attend. Call
the Sun HealthLine for more information or to register. This could be
the first step in regaining your physical health, quality of life and
self-esteem.



Drs. Newman and Forest are with Sun Health Obstetrics and Gynecology.
Dr. Dietrich is on the medical staffs of Sun Health Boswell and Del
E. Webb Memorial hospitals.