More urologists are familiar with this medical condition than members of TSLMS, but thanks to the new emerging treatment options, our membership should be seeing more and more women who are suffering from Stress Urinary Incontinence (SUI). That is why we have made it a specific topic at SCALE 2019 Music City and hope that many of you will attend the talk to take advantage of that.

What is SUI

As noted by the National Institutes of Health, this is a common form of incontinence in women and it comes with a significant set of negative outcomes that can have a devastating impact on their financial and social lives, as well as self esteem.

Defined as involuntary leakage on exertion or on sneezing or coughing. SUI affects approximately 13 million people in the United States alone and is much more prevalent in women than in men. Overall, 30% of women will develop SUI within 5 years after their first vaginal delivery. SUI is associated with significant social and financial costs. The social costs include personal embarrassment and curtailment of daily activities that may cause urine leakage. SUI is associated with depression, particularly in the elderly and in patients with an urge component. The annual financial cost associated with urinary incontinence in the United States was estimated to be $16.3 billion in 1995.The cost of incontinence pads and undergarments are borne directly by patients as they are usually not covered by health insurance plans. SUI is the most common form of urinary incontinence, occurring in pure or mixed forms in nearly 80% of women with incontinence, according to 2 European studies… Mixed urinary incontinence (MUI) is a term that applies to a combination of symptoms (SUI and UUI) and to a combination of urodynamic conditions (urodynamic stress incontinence and detrusor overactivity). Typically, women with MUI symptoms have more severe and bothersome incontinence than women with only SUI or UUI. It has recently been proposed that these mixed symptoms are the result of, rather than the cause of, more severe SUI.

The Urology Care Foundation has collected a great deal of information about SUI that is easy to read and understand, even for those who are not experts in the field. They explain in simple terms what causes this disorder:

The pelvic floor supports the bladder and urethra. If this area gets stretched, weakened or damaged, then SUI can happen. Pregnancy and childbirth can cause this. Chronic coughing or nerve injuries to the lower back or pelvic surgery (like surgery for prostate cancer) can also weaken the muscles… SUI impacts older women most often, however, it is not caused simply by aging or by being female. It happens in younger women and some men too. For some young women, it can result from childbirth, and then improve after time. Risk factors for SUI include:

• Gender: females are more likely to get SUI
• Pregnancy and childbirth
• Being overweight
• Smoking
• Chronic coughing
• Nerve injuries to the lower back
• Pelvic or prostate surgery

Traditional Treatment Options for SUI

There are a number of devices, surgeries, and injections that are traditionally used to control and/or correct SUI in women, as well as lifestyle changes and exercise routines that can make a difference.

Injections can be given that bulk up the urethral sphincter muscles, generally performed as outpatient procedures under local anesthesia – they may need to be repeated to be effective in some women.

Devices include those that are meant to “block or capture urine.” (Source). The Continence Product Advisor discusses the pros and the cons of both reusable and disposable internal vaginal devices:

Diaphragms and pessaries have been found to reduce leakage although diaphragms can cause discomfort and long-term use of pessaries can be associated with bleeding, extrusion (the device is pushed out), discharge and pain.

Intra-vaginal rings have been found to reduce leakage. However, they can be difficult to fit (especially in women who have had multiple vaginal surgeries) and are less effective in women with mixed urinary incontinence. Some women develop vaginal soreness or mild irritation and, less commonly, urinary tract infection.

Hollow tampon there is some research evidence that this device reduces leakage in some women and that women find it acceptable to use.

Tampons are a relatively cheap, easy and acceptable device to try and can be effective at reducing leakage.

A more recently developed device uses a soft nylon mesh that acts as a sling under the urethra. There is some research evidence that this device reduces leakage and is acceptable, although some women have experienced discomfort, pain and spotting with blood.

Some women get surgery that falls into one of two categories. Either sling surgery, in which a strip of material is placed under the urethra to hold it up, or bladder neck suspension. Both are relatively simple surgeries, but they come with surgical risks that not all women are happy to take on, especially when there is the alternative of energy treatments.

How Energy Treatments work for Female SUI

There are at least three different proven types of treatments that are non-surgical outpatient solutions for women suffering from SUI. Each uses a different technology, so it will be rare that the same office will offer all three. However, given the statistics on the prevalence of SUI, investing in at least one and offering the service may be a wise move for many medical spas and other providers.

The first is radiotherapy. Well studied and documented. Transurethral radiofrequency energy collagen micro-remodeling is the more precise name and definition of this treatment that works well for women with moderate to severe SUI. (Source).

Also using radio frequency is the Viveve System, which offers clinical grade and home-treatment devices. The distinction is that this uses cryogenically cooled technology.

There is also a laser option, which is minimally invasive and best used to correct early stage SUI. (Source). This is a technology that has been in use for almost a decade.

Any of these, or other emerging technologies will allow you to help a lot of women who are suffering.