Urinary Incontinence

Urinary Incontinence

Urinary incontinence is any involuntary and uncontrollable leakage of urine. Besides disrupting a person's comfort in daily life, constant wetness, irritation and worry about unpleasant odor can also lead to serious social and psychological problems. The frequency of urinary incontinence increases with age, and it is more common in women than in men.

Types of Urinary Incontinence

Stress urinary incontinence: Leakage of urine during exertion (coughing, sneezing, lifting heavy loads, exercise, etc.). So why does this happen?
The urinary channel (urethra) is held in place by pelvic structures like a hammock. Weakening of the structures that support this channel, or damage to the structure we call the sphincter, which allows urine to be held, results in stress incontinence. This is because when the sphincter mechanism does not work properly, it cannot close completely, and urine leaks out involuntarily as pressure inside the bladder rises during exertion.
Urge urinary incontinence: Leakage of urine that occurs together with a sudden urge that cannot be postponed. Here there are involuntary contractions in the bladder, and there is a problem with storing urine.
Mixed urinary incontinence: Both types of incontinence occur together.
Overflow incontinence: Involuntary leakage of excess urine in the form of dribbling when the bladder becomes full.
What Causes Urinary Incontinence?
Genetic predisposition
Weakness of the pelvic floor muscles
Neurological diseases
Hormone deficiency and menopause
Pregnancy and difficult births
Urinary tract infection
Previous prostate surgery
Previous urological, gynecological and bowel surgery
Prostate enlargement
Overactive bladder
Radiotherapy
Obesity
Congenital urological anomalies
Evaluation and Diagnosis
First, a detailed history is taken from the patient and a physical examination is performed. A voiding diary is kept to determine the severity of the incontinence. Urinalysis, urine culture, urinary ultrasound, post-void residual urine measurement, uroflowmetry, pad test, urodynamic study and cystoscopy are tests used when needed.

Treatment

Conservative Approach

Avoiding excessive fluid intake and regulating fluid intake
Limiting consumption of coffee, tea, alcohol and carbonated drinks
Weight loss and regular physical exercise in patients with obesity
Relieving constipation
Avoiding hot, spicy and sour foods that irritate the bladder
Encouraging smokers to quit
Bladder training and exercises that strengthen the pelvic floor muscles
Medication: Drug treatment is planned according to the type of urinary incontinence. The main drugs used in treatment are muscarinic receptor antagonists, mirabegron and estrogen. Other drugs include desmopressin and duloxetine. Because these drugs may have some adverse side effects and interactions with other medications, they must be used under the supervision of a urologist

Surgical Treatment

For Urge Urinary Incontinence:

Intravesical (Bladder) Botox Injection: This is a treatment method we use for overactive bladder, neurogenic bladder and painful bladder syndromes. In this procedure, which we usually perform under local anesthesia, Botox is injected into 20–30 points of the bladder using a special needle.

With an effect lasting approximately 6–12 months, this procedure aims to reduce involuntary bladder contractions and increase bladder capacity, thereby improving complaints such as frequent urination and urinary incontinence.

Sacral Neuromodulation (Bladder Pacemaker): It is used to treat urinary incontinence, urinary retention, refractory overactive bladder and painful bladder syndrome. In this technique, which we call sacral neuromodulation (bladder pacemaker), electrodes we place in the sacrum stimulate, with the help of a battery, the nerves that control bladder function, relieving the patient's complaints.

Bladder Augmentation Surgery (Augmentation Cystoplasty)

For Stress Urinary Incontinence:
Sling Surgery (TOT & TVT): Support that prevents urinary leakage is provided with a mesh placed through the patient's vagina. If there is no uterine or bladder prolapse, this 15-minute operation resolves urinary incontinence with a success rate of up to 90%, without serious side effects. Performed as a day-case procedure with the patient discharged the same day, the patient can see the effect of this surgery the next day.

-Burch Colposuspension

-Periurethral Injection

-Artificial Urinary Sphincter