Mr Christian Barnick | Obstetrician & Gynecology Consultant | The Portland Hospital
Urinary Stress Incontinence (USI) is extremely common in women particularly following childbirth. The first line of treatment is physiotherapy but where this fails surgical treatment may be required.
There are three mainstream surgical options. The current favourite is a tape placed under the midurethra. There is a highly competitive market in mid-urethral tapes, with many subtle differences between the products. The market leaders in this area are the TVT (Tension-Free Vaginal Tape) and the TVT-O (Tension Free Vaginal Tape – Obturator) both of which are widely used at The Portland Hospital.
Reported success rates for the treatment of USI are very high between 70% and 95%. Difficulties sometimes arise when offering secondary treatment if the TVT fails.
For example in a recent case, a 40 year old woman had undergone a previous TVT-O which unfortunately had failed. She still had significant symptoms of urinary stress incontinence. Video-urodynamics were performed which confirmed the diagnosis of Urodynamic Stress Incontinence. Real time X-ray imaging revealed that the bladder neck was wide open above the properly positioned tape.
After full discussion and consent it was decided to perform an operation to increase the bulk of the periurethral tissue at the bladder neck in order to aid urethral closure.
The patient was admitted as an outpatient day case and had a total of 2mls of Bulkamid injected at three sites around the bladder neck under general anaesthesia. The procedure was successfully completed in just 15 minutes and she was discharged to go home once a bladder scan had confirmed that she was voiding properly.
This case demonstrates the need for careful assessment of patients using highly specialised investigations, and the use of innovative techniques to solve this troublesome problem. Both the advanced technology and the expertise are now available at The Portland Hospital for the treatment of Urinary Stress Incontinence.
For further information on USI treatment please contact Mr Christian Barnick, Obstetrician & Gynecology Consultant at The Portland Hospital on 020 7390 8440.