BACKGROUND: Stress urinary incontinence (SUI) is the most common type of urinary incontinence, affecting 15 million women in the United States alone. SUI is the involuntary leakage of urine which occurs during periods of increased intra-abdominal pressure ("stress").
CAUSE: The primary cause of SUI is inadequate support of the bladder resulting in leaks during activity. SUI affects women of all ages, including approximately 25% of women age 30-59 years, particularly those who have delivered at least one baby vaginally.
Recommended Videos
Other factors that may worsen stress urinary incontinence include: urinary tract infection, obesity, smoking, diabetes, excessive consumption of alcohol or caffeine, and sports like running or tennis. (Source: Mayo Clinic)
COMMON SYMPTOMS: If you have SUI, you may experience urinary leakage when you: cough, sneeze, laugh, stand up, lift something heavy or exercise.(Source: Mayo Clinic)
SURGICAL OPTIONS:
- Injectable bulking agents: Collagen, synthetic sugars or gels may be injected into tissues around the upper portion of the urethra. These materials increase pressure on the urethra, improving the closing ability of the sphincter. Because this intervention is relatively noninvasive and inexpensive, it may be an appropriate treatment alternative to try before other surgical options.
- Open retropubic colposuspension: This procedure is often used to treat women with stress incontinence. Sutures attached either to ligaments or to bone lift and support tissues near the bladder neck and upper portion of the urethra.
- Sling procedure: In this procedure most often performed in women, the surgeon uses the person's own tissue or a synthetic material to create a "sling" that supports the urethra. Slings for men are used less frequently, but this surgical approach is under investigation. A recently developed technique using a mesh sling has proved effective in easing symptoms of stress incontinence in men. (Source: Mayo Clinic)
RENESSA: Renessa is a non-surgical treatment for women who experience SUI. The Renessa treatment uses a small device which your physician passes through your urethra. It involves the controlled heating of microscopic tissue sites at the base of your bladder, after which the device is immediately removed.
There are no catheters, bandages or dressings to change. It takes about 45 minutes. The full effect of treatment is typically seen within 60-90 days. (Source: renessa.com)
Dr. Royce T. Adkins, Affiliated with Tennessee Woman's Care, and a Clinical Instructor at Vanderbilt University talks about urinary incontinence.
Can you talk about urinary incontinence?
Dr. Royce Adkins: Stress urinary incontinence is one of the more common things that I see every day. Over 25 million women across the country have this condition. The majority of women after having children present with some degree of incontinence.
What is urinary incontinence?
Dr. Royce Adkins: The typical patient with stress incontinence loses urine when they do anything to increase pressure in her abdomen; a cough, a sneeze, a jump up and down, running, jogging any sort of activity at all usually will cause that her bladder to leak. As a result, the patient has soiled her undergarments and may have an embarrassing situation and can even have urine running down her legs. I have so many patients who have told me over the years "oh I had this episode and I had to change clothes" or "I'm wearing these thick pads", "I used to work out but I can't work out anymore" and it really affects patient's daily activities. I have several patients that have been somewhat reclusive as a result of it.
What are some of the treatment options?
Dr. Royce Adkins: Well over the years most procedures have been surgical. There are really no medications that have been significantly successful. In the last few years we actually opened the abdomen. In the last 20 to 30 years there's been more of an out-patient approach primarily with slings like a hammock to lift the neck of the bladder up to provide that support that otherwise was missing. The sling material is made out of mesh which is a polypropylene type mesh. Unfortunately there really hasn't been a lot of other minimally invasive surgeries outside of that in the last several years. Most patients have heard that there's an FDA warning associated with prosthetic mesh and as a result, many patients hesitate to have these sling procedure done because of the risk of infections, pain, difficulty with intercourse. As a result, Renessa has become more and more widely requested. Patients are beginning to look at minimally invasive procedures we can do in the office, not only for the expense savings, but also for the ability to avoid prosthetic mesh.
Can you tell us about Renessa?
Dr. Royce Adkins: Essentially, you apply very low dose energy, and it's called RF energy, which really transmits to heat. The heat is about the temperature of a cup of coffee. It's not anything that's not tolerated by the human body and has safely been used in many other surgical procedures for years. It's applied into the base of the bladder and around the urethra that affects the collagen. Collagen, as most patients are aware, controls wrinkles and other skin functions in the body. We have collagen in many of the tissues. In fact, there's collagen around the base of the bladder as well. This low dose heat allows the collagen to re-shape or tighten if you will, and over the course of 2 or 3 months then that collagen begins to get a little tighter and this allows the patient to have better control and more continence. Typically after the procedure some patients will notice some improvement within the 1st week or two, but honestly, it usually takes a good 2 to 3 months before you see significant results. Almost always by 6 months many patients are dry. Of course the majority of patients that have had this done are certainly improved from where they were to start with.
How many people can he helped with Renessa?
Dr. Royce Adkins: Based on the experience of others and in our experience using this product for the last 3 years, about 75% of the patients have had marked improvement.
How does it work?
Dr. Royce Adkins: Radio frequency is a very safe method of applying heat to tissues and it's really been used in medicine and surgery for years. In fact, that's how we cauterize blood vessels in many types of surgery. We don't want to burn the tissue, we don't want to scar the tissue, we just want to heat the tissue gently enough to allow that collagen to shrink and become tighter around the base of the bladder to enable the patient to have continence again.
Is it all done with local anesthesia?
Dr. Royce Adkins: It's really quite simple. It is like going to the dentist. The patients are wide awake and we talk to them. It takes about 9 to 10 minutes to actually do the procedure. Most patients drive themselves home from the doctors' office and go back to full activity that day, especially the following day, so there's no long term recovery. In fact there's no incisions, no IVs. That's the beauty of this, it really is a simple as getting local anesthesia, and then walking out and you're finished.
What should patients know about Renessa?
Dr. Royce Adkins: I think the main issue for Renessa is increasing the patients' knowledge base. Many women are a little embarrassed or nervous to bring this up at times and more and more physicians have to start that conversation if you will. We have done this for years in our office, and many women go to their gynecologist for such issues, not so much to their primary care doctor. In fact, most women think that their gynecologist is really their primary care doctor for most of their reproductive needs and pelvic and as a result, I do think it's incumbent upon us to make sure that women are aware of these options, especially now that so many women are concerned about the FDA mesh warnings.
How much does Renessa cost?
Dr. Royce Adkins: The cost of the procedure is usually somewhere between $1500 and $2500 compared to at least $10,000 to $15,000 for the slings performed in an out-patient surgery center. Now with the FDA warnings many patients are not as inclined to do these procedures. In some communities, urologists are the only people trained to do these procedures as well. The fact that now we can do this in the office and any gynecologist would have no problems at all doing these procedures with minimal training.
Is there a down side?
Dr. Royce Adkins: They are side effects to every medical procedure from major to minor, including anesthesia related complications. When you look at large volumes of patients, Majority of the reported side effects have been minimal. There is a certain percentage that patients that may not receive any real benefit from this, but if the patients are carefully screened, there hasn't been any significant long term difficulty in urination, and a great majority of these patients have had significant results in controlling their incontinence.
FOR MORE INFORMATION, PLEASE CONTACT:
Royce T. Adkins, MD
Tennessee Women's Care
(615) 301-1000