This spans all the urinary issues such as incontinence to overactive bladder and poorly functioning bladder.

Overview

About Voiding Dysfunction

Voiding dysfunction can encompass many disorders for many reasons. There can be anatomical causes of voiding dysfunction as well as neurological causes.

Urinary incontinence is when a patient is unable to control urine flow.

There are four types of urinary incontinence:

Stress Incontinence

A pressure on the abdomen and pelvis, such as sneezing, coughing or laughing, exercise will cause leak of urine.

Urge Incontinence

Sudden urge to urinate followed by leakage of urine.

Mixed Urinary Incontinence

Combination of both stress and urge incontinence.

Overflow Incontinence

Since the bladder is never completely empty this causes leakage of the overflow of urine.

Overactive Bladder

Overactive bladder occurs later in life and is a common condition. This is where the bladder has the sensation to void or spasm to void without actually stimulation from a full bladder. There is a variety of causes from neurologic to hormonal.

Non-Obstructive Urinary Retention

This condition is characterized by the inability to completely empty the bladder but not from blockage of the urinary channel. This is usually due to some underlying cause of bladder weakness. The patients will have weak of dribbling stream or urine.

Diagnosis

Diagnosis

  • A urinalysis, cystoscopy (looking into the bladder)
  • Urodynamics (the study of bladder function and urine flow)
  • Bladder scan (ultrasound of bladder which measures the amount of urine left in the bladder)
Treatment

Voiding Dysfunction Treatments

Non-surgical and Behavioral Techniques

Pelvic floor therapy is one of many treatments for voiding dysfunction. Medication, Kegel exercises, biofeedback, timed voiding and bladder training are a few options used by urologists.

Injections

If lifestyle changes and prescription drugs don’t work for you, or the drug side effects are serious, then botulinum toxin, better known as Botox®, is injected into your bladder muscle by way of a small flexible camera in the office. This works well for overactive bladder or urge incontinence. The drug can paralyze muscles to keep it from contracting too often. It may need to be repeated in 3 to 6 to 8 months. Risks include infection and retention of urine.

Stimulating Nerves (Neuromodulation Therapy)

Sacral neuromodulation (SNS)

This treatment will work by stimulating the sacral nerve (near the base of the spine) that goes to the bladder. SNS therapy basically uses a “bladder pacemaker” to interrupt these signals from the bladder to the brain, which can improve OAB symptoms like urgency and frequency. This device delivers electrical impulses to the bladder to essentially stop the signals from the spinal cord that cause OAB. Risk can include site infection, neuron damage, spinal cord bleeding, and rarely infection.

Percutaneous tibial nerve stimulation (PTNS)

This in office minimally invasive therapy stimulates the tibial nerve. PTNS is performed during an office visit that takes about 30 minutes but requires 12 treatments. A small acupuncture needle electrode is placed in your ankle. Gentle electrical pulses are sent to the tibial nerve which runs up your knee to the sacral nerves. The electrical pulses help block the nerve signals that aren’t working correctly.

Surgery

Several minimally invasive procedures as well as more extensive surgical procedures may be necessary to treat voiding dysfunction.

Urethral Injections for Stress Incontinence

Urethral Injections/Bulking Agents

Using types of collages, the doctor can “bulk up” the urethral sphincter muscle to keep the urethra closed. “Bulking agents” are injected into the urethra using a camera. The injections can be repeated every 3 months if needed. This method is not as effective as other surgeries called a urethral sling, but there is minimal down time. Bulking agents are a temporary treatment.

Surgery For Women with SUI

Sling surgery is the most common treatment for women with stress incontinence. A small strip of synthetic mesh or your own fascia is placed under your urethra as a hammock to support the urethra.

Two types of sling exist:

  • Midurethral sling – The midurethral sling is the most common type of surgery used to correct SUI. The sling is made out of a narrow strip of synthetic mesh that is placed under the urethra with a variety of techniques: retropubic, transobturator and single-incision.
    • For sling surgery made from surgical mesh, the surgeon may only need to make a small cut (incision) in the vagina. The sling is then inserted under the urethra and anchored in the surrounding pelvic floor tissue. This surgery is short and recovery may be shorter than with an autologous sling. There are additional risks associated with using mesh that you should discuss with your surgeon.
  • Autologous sling – In this type of surgery, the sling is made from a strip of your own tissue (autologous) taken from the lower abdomen or thigh. The ends of the sling are stitched in place through an incision in the abdomen.

Bladder Neck Suspension

Bladder Neck Suspension is also called Retropubic Suspension, Colposuspension or Burch Suspension which is usually done at the time of a hysterectomy. In this surgery, sutures are placed in the tissue along the side of the bladder neck and urethra to support the urethra and sphincter muscles to prevent them from moving downward and accidentally opening. There are certain risks with this surgery and should be discussed with your doctor.

Surgery for Men with SUI

Artificial Sphincter

The most effective treatment for male SUI is an artificial urinary sphincter device.

This device has three parts:

  1. A fluid-filled cuff (the artificial sphincter), surgically placed around your urethra.
  2. A fluid-filled, pressure-regulating balloon, inserted into your belly.
  3. A pump you control inserted into your scrotum.

The artificial urinary sphincter cuff is filled with fluid which keeps the urethra closed and prevents leaks. When you press on the pump, the fluid in the cuff is transferred to the balloon reservoir. This opens your urethra and you can urinate. Once urination is complete, the balloon reservoir automatically refills the urethral cuff in 1-3 minutes.

Artificial sphincter surgery can cure or greatly improve urinary control in more than 7 out of 10 men with SUI. Results may vary in men who have had radiation treatment. They also vary in men with other bladder conditions or who have scar tissue in the urethra.

Male Sling for SUI

The male sling is usually used for only mild SUI. It is less effective and not recommended in men who have had radiation therapy to the prostate, pelvis, rectum or urethra. The male sling is a narrow strap made of synthetic mesh placed under the urethra through small surgical incisions near the scrotum. The procedure is outpatients. Risks including injury to urethra, bladder, urinary retention, mesh erosion or infection.

Oral Medications

Anticholinergics

How they work

Anticholinergic drugs block the action of a chemical messenger acetylcholine so the bladder has less contractions.

Anticholinergic medications include:

  • Oxybutynin (Ditropan XL, Oxytrol)
  • Tolterodine (Detrol)
  • Darifenacin (Enablex)
  • Solifenacin (Vesicare)
  • Trospium
  • Fesoterodine (Toviaz)

Side effects include:

  • Dry mouth
  • Constipation
  • Do not use if you have glaucoma

Mirabegron (Myrbetriq)

Can treat mostly urge urinary incontinence and overactive bladder. Mirabegron relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It will also help to empty your bladder more completely because the bladder hold more urine.

Side effects include:

  • Nausea
  • Diarrhea
  • Constipation
  • Dizziness
  • Headache
  • Increase blood pressure

Estrogen

Low-dose, topical estrogen in the form of a vaginal cream, that can rejuvenate deteriorating tissues in the vagina and urinary tract and relieve some incontinence symptoms.

Estrogen cream is not recommended if you have a:

  • History of breast cancer
  • Uterine cancer
  • DVT or deep vein thrombosis

Imipramine

Imipramine (Tofranil) is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. It may be used to treat mixed incontinence when there is both urge and stress incontinence.

Usually taken at night because it can cause drowsiness.

Side effects include:

  • Irregular heartbeat
  • Dizziness
  • Fainting from reduced blood pressure
  • Dry mouth
  • Blurry vision
  • Constipation

Duloxetine

How it works

Duloxetine (Cymbalta) is a serotonin and norepinephrine reuptake inhibitor that is approved to treat depression. Studies suggest it might work for both urinary incontinence and depression.

Side effects include:

  • Nausea
  • Dry mouth
  • Dizziness
  • Constipation
  • Insomnia
  • Fatigue

When to See a Provider

Submit an online request for an appointment or call 310-582-7137 if you are unable to control urine flow or have other signs or symptoms that worry you.