Female Urology and Incontinence

Urinary incontinence (UI) or the involuntary leakage of urine is a distressing and serious health problem. Its psychosocial and economic burden leads to significant quality of life issues. UI is more prevalent than hypertension, depression and diabetes, yet under-reported with fewer than half of all patients willing to report their symptoms to their physicians. The urological surgeons at The University of Kansas Hospital are skilled at diagnosis and treatment of these conditions. Female gender alone is a predisposing factor for UI, most affected by childbearing and number of pregnancies. The three most common types of UI are stress urinary incontinence (SUI), urge urinary incontinence (UUI), or a combination of both, mixed urinary incontinence (MUI). ). The International Continence Society defines SUI as involuntary leakage on effort or exertion, or on sneezing or coughing. UUI refers to involuntary leakage accompanied by or immediately preceded by urgency. MUI is defined as a complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing.

SUI results from bladder neck/ urethral hyper-mobility and/ or neuromuscular defects, i.e. intrinsic sphincter deficiency. This occurs when the intra-abdominal pressure exceeds urethral resistance. Among women, these changes occur due to weak collagen, advanced age, pregnancy, obesity, advanced pelvic prolapse and chronic obstructive airway disease. Patients and our fellowship-trained physicians can help you choose between conservative, non-surgical (intra-urethral plugs, pessary, pelvic floor physical therapy), minimally invasive (bulking agents, mini-sling), and surgical (pubovaginal sling) treatment options for female SUI. Dr. Tomas Griebling and Dr. Priya Padmanabhan are the only fellowship trained female and voiding dysfunction urologists in Kansas and Missouri, offering the latest techniques in diagnosis and management of difficult female urologic problems. Our facilities provide “state of the art” videourodynamic equipment to provide specific information about even the most complicated conditions in the bladder and urethra. Dr. Griebling and Dr. Padmanabhan have specialized training in interpreting the results of such testing to ensure proper management of their condition.

UUI is considered classically due to an overactive bladder muscle (OAB) or an incompetent urethral sphincter. The underlying pathophysiology of OAB can relate to alterations in any of the reflex cycles in normal urination or structural changes in the smooth muscle, nerves or lining of the bladder. Treatment of OAB is based on diagnosis after excluding other pathologies, i.e. urinary tract infection, bladder stone, diabetes, or neurological conditions such as Parkinson's disease or multiple sclerosis. Options include conservative management (lifestyle modification, bladder training), drug therapy, and minimally invasive treatment (Botox) and surgical measures (sacral nerve stimulation, InterStim® ). The principles of treatment are to increase voided urinary volumes (thereby reducing urinary frequency and nighttime urination), decrease urgency and reduce UUI episodes. Dr. Griebling is nationally recognized for his contributions in geriatric incontinence and has the largest experience with sacral neuromodulation in the area. Dr. Padmanabhan has had success with Botox for certain patients crippled with incontinence that was unresponsive to other treatments.

MUI is often treated as part of the treatment of SUI and UUI. This approach should be individualized, depending on the severity of each component.

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is due to thinning or stretching of the collagen fibers in the connective tissue holding up the uterus, bladder, rectum and/or perineum. POP affects over 30% of all women and 50% of women who have delivered a child.  It is often described as “a woman’s hernia” and may worsen with aging, requiring repair. This often presents as a bulge in the vagina, which may disappear while lying down. Other presentations may be difficulty with emptying of the bladder or bowels, pain or pressure in the vagina, recurrent urinary tract infections, or limitations with sexual intercourse. Drs. Priya Padmanabhan and Tomas Griebling are fellowship-trained urologists in Kansas and Missouri with extensive knowledge in the diagnosis and treatment of POP. Diagnosis generally involves assessment with videourodynamics, a “state of the art “ test providing specific information about conditions of the bladder and urethra. This is especially beneficial in the management of urinary incontinence, which often goes hand-in-hand with prolapse. At KU, treatment options available for prolapse treatment include: conservative (pessary), transvaginal (cystocele repair, sacrospinous ligament fixation, rectocele repair, and colpocleisis), and abdominal approaches, including the historical, gold standard, abdominal sacrocolpopexy and newer robotic sacrocolpopexy. Treatment is planned with a personalized approach addressing each woman’s needs.

Spinal Cord Injury

Many patients who have suffered a spinal cord injury develop problems with urination, sexual function, or fertility. This may include either overactive bladder with urinary incontinence or urinary retention with difficulty emptying the bladder. Both men and women can experience problems with sexual function after spinal cord injury. Men may suffer from problems obtaining or maintaining erections. Both men and women may experience difficulties with orgasm and sexual satisfaction. Men who have suffered a spinal cord injury may also have difficulty with ejaculation which can lead to issues with fertility. Dr Nangia specializes in the care of men with these issues. KU has a Comprehensive Spinal Cord Clinic which helps to coordinate care for patients with spinal cord injuries across multiple medical specialties. Drs. Tomas Griebling and Priya Padmanabhan have specialized training in neurolurology and provide urology services for the Comprehensive Spinal Cord Clinic .

If you suffer from incontinence, don’t wait another day. Make an appointment to talk about your options for a permanent solution that can help you restore your quality of life…and live life dry!

As with any surgical procedure, inherent risks are present. Although rare, some of the most severe risks may include infection and erosion, surgical, physical, psychological or mechanical complication. If these occur, they may necessitate revision or removal of the device. For additional product and risk information, Contact Us today.

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