By Christopher Pearson
Stress urinary incontinence is a complicated term simply defined as the unexpected leakage of urine due to physical pressure placed on the bladder. It is a problem experienced by as many as one in three women in the United States. At a minimum, the condition can be embarrassing and annoying. For some women, stress urinary incontinence can profoundly affect their quality of life. After all, one of the primary rites of passage during the toddler years is the ability to hold one’s urine. Any reversal of that basic achievement in adulthood can be traumatic and stress-inducing.
The Best Treatment
Urogynecologist Jaime Sepulveda M.D. has successfully treated more than 2,000 women suffering from stress urinary incontinence using a device known as the mesh midurethral sling. The sling is placed using local anesthesia during a 25-minute outpatient procedure.
According to Dr. Sepulveda, the American Urogynecologic Society and nine other worldwide medical organizations concerned with female pelvic medicine, the mesh midurethral sling is the safest, most effective and durable treatment for stress urinary incontinence.
“Cure is more important than improvement” explained Dr. Sepulveda. “The highest level of medical-scientific evidence demonstrates that in the treatment of clinically confirmed urinary stress incontinence conservative treatments such as pelvic floor exercises and behavior modification will only improve the condition, whereas the mesh midurethral sling will cure it. After more than 2,000 documented studies, the science is crystal clear on the efficacy, durability and safety of midurethral synthetic slings for the treatment of urinary stress incontinence.”
In fact, there have been more studies completed on the mesh midurethral sling than almost any other medical procedure in history. And in 2016, the American Urogynecologic Society issued a statement touting the procedure as the safest and most effective treatment for stress urinary incontinence.
Underlying Issues and Early Treatment
While a number of common factors can be responsible for stress urinary incontinence, including advancement in age, a history of multiple natural childbirths and obesity, some women find that mundane activities such as sneezing, coughing and laughing can cause urine leakage.
“Simply explained, when pressure is exerted on the bladder through activities ranging from a simple sneeze to a good exercise session, urine can leak out through a poorly supported urethra,” said Dr. Sepulveda. “Think of a stretched dock line holding a boat a float, it will easily sink with weight. A miduretrhal sling replaces the stretched or broken supporting structure of the urethra, the tube valve that keeps urine in the bladder.”
As recently as the 1980s, the primary treatment for stress urinary incontinence was placing sutures at the junction of the urethra and bladder, a very sensitive area. This required general anesthesia, an abdominal incision and a lengthy recovery period. Not only was there a risk of complications from this major surgery, in some cases the sutures caused obstructions, difficult urination and contributed to bladder overactivity. Unfortunately, new problem of urinary frequency, urgency and incomplete bladder emptying were created complicating the treatment of the initial issue.
The solution was straight out of “Back to the Future.” Polypropylene sutures had been widely used in operating rooms for 50 years. A finely knitted mesh sling was invented using the suture material and found to be well tolerated by patients, safe and durable. Studies and more studies were conducted, all finding the mesh midurethral slings to be the safest and most effective treatment option. Studies were undertaken to unprecedented quality, scrutiny and follow up. The most recent ones evaluate the experience seventeen years after the initial surgery.
Show Me the Facts
In the past, American consumers were barraged by media reports of problems with mesh midurethral slings. Although there are risks with all continence surgical procedures, Dr. Sepulveda says that clinical evidence should be the basis of a decision on the type of treatment of urinary stress incontinence. “A television commercial from a law firm explaining the potential risk of any type of intervention is not news and definitely not medically sound, regardless of how many times is shown.” Dr. Sepulveda said. “There is a possibility that mesh midurethral slings may no longer be produced because of a type of litigation that has a disconnect from the current medical and scientific evidence.”
Synthetic midurethral slings are the current clinical standard for the treatment of urinary stress incontinence. The use of midurethral polypropylene implant is supported by over 2000 medical studies and the prestigious Cochrane Scientific Collaboration (cochrane.org). As with other implants used in the human body to replace defective tissue or a broken structure a risk of revision exist with synthetic midurethral slings. Revision is the professional term used to describe a reintervention for a surgical procedure or an implant. It is a risk that exists even if your own tissue is used. When studied at 10 years, the risk of requiring a midurethral sling revised is as low as 2%-3%. For comparison, joint replacements have a 6 % to 12% rate of revision and breast implants are revised at rates over 25%.
Patients suffering from stress urinary incontinence should prepare ahead of their consultation in order to have a relevant, evidence based conversation about their surgical options. Professional societies such as the sites of the American Urogynecologic Society, The American Urological Association, The International Urogynecologic Association and the Cochrane library are reliable sources conversation. “Your surgeon’s experience and expertise matters” Dr. Sepulveda said. “The way to preserve and improve our current clinical standards is through an evidence based approach, we are all part of the process, patients, scientists and health professionals. We do not want to imagine going back to the old treatments where the risk of complications is higher, the efficacy is lower and recovery longer, based on anecdotes or a lack of knowledge of the reliable medical and scientific evidence available today.”
Dr. Jaime Sepulveda’s practice is located at 6200 Sunset Drive, Suite 504, in South Miami. For more information, call 305-669-6267 or visit www.miamiurogynecologycenter.com.