The urinary incontinence or loss of bladder control It is a very common problem that often causes embarrassment and can affect a person’s lifestyle.
(The technique of the robotic female artificial sphincter that ends urinary incontinence)
To resolve doubts associated with urinary incontinence, we talked with David Carracedohead of the Functional-Female Urology Unit at ROC Clinic.
Who does urinary incontinence affect? What profile of women?
The involuntary loss of urine affects the quality of life of the person who suffers from it. It is estimated that approximately 1 in 3 women will suffer from urinary incontinence throughout their lives, therefore, we are talking about a problem that affects millions of women in our country.
We can define three large groups of patients, according to the type of urinary incontinence they present:
- stress urinary incontinence.
It consists of the involuntary loss of urine associated with physical exertion or exercise. The best known is the loss of urine when coughing, sneezing or laughing, but in more serious cases it can be present with small efforts such as walking, getting up from a chair or changing posture.
Risk factors for stress urinary incontinence are: number of pregnancies and vaginal deliveries, instrumental or traumatic deliveries with tears, obesity, smoking, or lung diseases that cause chronic cough.
- Urge urinary incontinence.
It consists of the involuntary loss of urine preceded by an irrepressible desire to urinate, which we define as urgency. Under normal conditions, when we have a desire to urinate, we can delay it long enough to get to the bathroom. However, in these patients, the desire appears suddenly and the urine escapes before it can reach a suitable place to urinate.
Risk factors for urge urinary incontinence or worsening symptoms are: advanced age, consumption of exciting substances (tobacco, alcohol, caffeine, theine) or pelvic organ prolapse.
- Mixed urinary incontinence.
They are those patients who present both types of incontinence at the same time. It is very common to find the two types of incontinence associated in the same patient, which worsens the condition and makes it more complex to resolve.
What does suffering from urinary incontinence affect?
Urinary incontinence produces a great impact on the quality of life of patients who suffer from it, modifying their habits and customs, to organize them around incontinence. For example, planning urination throughout the day to avoid incontinence (urinating before leaving the house to avoid leakage), doing scheduled activities only where you know you will have a bathroom nearby, preparing absorbents or change of clothes before leave the house in case you need it, etc.
On the other hand, urinary incontinence produces significant social isolation, reducing social activities and contacts due to fear of suffering incontinence episodes in public places or in front of other people.
This social isolation is especially serious in the elderly, who, on the one hand, are already vulnerable to suffering from this situation for medical-social reasons and, on the other hand, are one of the population groups where urinary incontinence is more prevalent.
In younger women, the impact of incontinence occurs in two ways. On the one hand, urinary incontinence can affect the workplace (sick leave, the need to adapt to the job, etc.) and, on the other hand, it can also affect the sexual sphere, limiting sexual relations due to fear of suffering incontinence during them.
Urinary incontinence can also trigger other diseases or medical problems such as urinary tract infections, skin problems in the genital or gluteal area, and even increasing the risk of falls and bone fractures.
Until now, refractory stress urinary incontinence in women did not have adequate treatment. What is the new technology that is revolutionizing this problem?
The treatment of stress urinary incontinence is staggered, from less invasive measures to more invasive measures. We usually start with pelvic floor rehabilitation for at least 6 months, performing pelvic floor or hypopressive exercises.
When these measures are not enough, it is decided to perform a surgical treatment, usually the implantation of a mesh below the urethra, with success rates of approximately 80-85%.
The problem lies in this 15-20% of patients whose stress incontinence does not resolve with this treatment. On many occasions these patients have severe stress incontinence and end up undergoing multiple mesh implants or other surgeries, which fail to resolve their problem.
Currently, in these patients, we carry out a detailed and individualized diagnosis, using the most advanced diagnostic methods, such as pelvic floor ultrasound or videourodynamics. When we find that the patient’s own sphincter is not working properly, then we indicate treatment using a robotic female artificial urinary sphincter, with excellent safety and efficacy results.
Thanks to robotic technology, we can perform the implant in a minimally invasive way, with a hospital stay of 24 hours and with a very low number of complications compared to open surgery.
What does it consist of?
The robotic female artificial urinary sphincter is a minimally invasive technique that aims to replace the function of the damaged sphincter with an artificial sphincter.
The sphincter is a hydraulic system, consisting of three components:
And sleeve which is placed around the neck of the bladder hugging it. It is the most important component, since it ensures that the patient is continent (by being closed when the patient does not want to urinate) and that she can urinate when she wishes (opening when the patient wants to urinate).
A trigger pump placed on the labia majora of the vagina. It is the component that activates and opens the cuff to achieve urination. When the patient wants to urinate, she activates the pump by gentle pressure and the cuff is opened to achieve urination.
And serum reservoir that is placed adjacent to the bladder and that contains the liquid (physiological serum) that allows the functioning of the two previous components.
The surgery is done through small incisions (less than 1 cm), through which, with robotic assistance, we perform the entire procedure.
First, we dissect the bladder neck around which we will place the sphincter and the paravesical spaces where we will place the reservoir.
Subsequently, once the two previous elements are in place, we implant the activation pump in the labia majora, we create the connections between the different elements, and the device would already be implanted.
How long does the intervention last? What type of anesthesia does it require?
It is a procedure that is performed under general anesthesia in a period of approximately 2 hours.
Today, thanks to minimally invasive robotic surgery, we can do it quickly, with minimal risk of infection or complications, and with a 24-hour hospital stay.
When are the results perceived? after how long
After the intervention, as we have commented before, the patient is discharged in 24 hours and 5-7 days after the intervention we remove the bladder catheter.
After surgery, we keep the artificial sphincter inactivated for 6 weeks to allow the swelling to subside. After this period, we instruct the patient in the management of the sphincter and proceed to activate it.
Once activated, the device is already working and the patient regains her continence.
Therefore, we can say that, after a period of approximately 6 weeks, the patient can begin to manage her sphincter, recover her continence and, consequently, also return to her usual life without the limitation of incontinence.
Our team currently has extensive experience in the treatment of patients with complex stress urinary incontinence using a robotic artificial urinary sphincter, with very good continence and safety results.
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