December 2016, Newsletter

Dear Patients,

We want to wish all of you a Merry Christmas and Happy New Year.  At AWHC, we’re so grateful to be able to serve your OB/GYN and cosmetic surgery needs, and to serve the Lord by always doing this to the best of our abilities.  We hope we’re able to meet your needs and expectations.  If ever you feel we are not meeting your needs, please let us know so we can address it immediately.  We have a new managerial staff to help you, Viridiana Zuniga and Francisco Horta.  Please ask to speak to either one of them if you have questions or suggestions.

Dealing with Social Situations and Incontinence

This is the season of our Savior’s birth, and we enjoy celebrating this time with family and friends. We want to provide some medical information that is relevant to social situations for many of you or people you know.  Leaky bladders are a problem for many women.  Today, we call this Stress Urinary Incontinence or SUI.  Another name is Genuine Stress Urinary Incontinence (GSUI), indicating the incontinence has been tested and confirmed by a medical test.  But either terms are used to describe a situation that is bothersome, embarrassing, and sometimes even medically problematic as it can cause infections on the skin.  SUI is leakage of urine that occurs with internal pressure on the bladder, like coughing, sneezing, laughing, jumping, exercising, or even during intercourse.  The pressure or force is the “stress.”

It is estimated that approximately 4-35% of all women suffer from SUI.  Numerous risk factors are attributed to SUI including age, obesity, smoking, and child birth.  SUI can also cost patients a lot of money.  Some studies indicate up to $1,000/year in incontinence pads, laundry, and routine care.  Numerous studies also show that urinary incontinence has a significant cost on the quality of life for individuals.

Diagnosing SUI consists of first discussing the issue with your OB/GYN, and sometimes additional testing such as urinary dynamic testing and cystoscopy are ordered. These are both tests that can be done in the doctor’s office with numbing gel as the only form of anesthesia needed. With these tests, the doctor can evaluate your bladder for causes of incontinence, look for cancer, and stage your incontinence as mild, moderate or severe. Such staging helps your doctor decide on which form of treatment is best for you.

There are numerous options for treatment of SUI, from non-surgical to surgical options.  The non- surgical options include a pessary, a soft silicone device that is placed in the vagina, holds up the bladder and helps decrease or stop SUI.  Other non-surgical options include kegel exercises and physical therapy for the pelvic floor, bio-feedback, and vaginal weights used to build up and strengthen the pelvic floor muscles.

Procedural options for SUI include many treatments other than the sling of transvaginal tape, also called TVT.  But first a little about the TVT and why it has received negative media attention lately.

The TVT is still FDA-approved and it is still recommended for the treatment of SUI, but has been found to have higher rates of complications than we previously thought. This complication rate was previously thought to be 1-2%, but now it’s thought to be closer to 4-15%, which is still relatively low. One benefit the TVT has over other surgical options is that it is thought to last longer than most other procedures; the average time is 10 years before possibly needing a replacement.

The other procedural options include urethral bulking injection such as the Coaptite. This is a simple injection into the urethra with a collagen-like substance that increases the thickness of the opening to the bladder in the urethra. This makes it harder for urine to leak out when a “stress” occurs like a cough, sneeze, or laugh.  This procedure has minimal complications or side effects.  It’s about 85%-90% effective in stopping or reducing the leaks associated with SUI. The main drawback is that this procedure may not last as long as the TVT. Most people may need touch ups or another procedure in about 2-5 years. It also avoids the potential TVT side effects, such as mesh erosions.  Urethral bulking injection remains a good option for many who are concerned about mesh options, and it’s covered by most insurances.

Another recent exciting treatment for SUI is platelet rich plasma (PRP) injections to the urethra. This procedure has been coined the “O-shot” and is offered at AWHC. This procedure is the ultimate in “no foreign body” treatment options for SUI because it does not use collagen (used in the urethral bulking procedures), poly propylene (used in TVT procedures), or any other substance that is foreign to your body. PRP is derived from your own blood, which is drawn from the patient in a simple blood draw. The PRP is usually injected in the clitoris and G-spot during the same visit, giving the additional benefit of improving sexual  function and orgasm sensitivity, thus it was named the “O-shot.” The O-shot is not presently covered by medical insurance. The cost ranges from $1,200-$1,500. For a limited time, AWHC will perform this procedure for $900. When you consider that you avoid the hospital, do not have to pay insurance co-pays or deductible fees, avoid general anesthesia and a Foley catheter (which all occur with traditional SUI procedures), the O- shot is very good option.

We hope that explaining this issue and treatment options is helpful and informative. This is a lot of information, and many of you may have more questions about urinary incontinence. Please call AWHC to schedule an appointment with one of our physicians who are specially trained in any of these procedures. Our number is 661-410-2942.

Thank you for choosing AWHC for your OB/GYN and cosmetic surgery needs.

Wishing you a blessed 2016,
Jason Helliwell, MD and Siniva Kaneen, MD

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