The Future of Bladder Leakage Surgery

By Paul J. Watkins

When it comes to bladder leakage, many women want to try conservative, or non-surgical, treatments first. Whether it's Kegel exercises, biofeedback, medications, or pessaries (removable devices placed into the vagina to support the pelvic organs), there are several options for those who want to avoid the operating room. As effective as conservative treatments are for many women, the fact is that no treatment works for every woman. Some women have tried many nonsurgical treatments and have gotten unsatisfactory results. For them, surgery is often the next step.

Kenneth M. Peters, MD, is a board-certified urologist who is Fellowship trained in Voiding Dysfunction (problems with going to the bathroom.) In addition to practicing at Beaumont Comprehensive Urology Center, he is Chairman of the Department of Urology at Beaumont Hospital in Royal Oak, Michigan, where he also serves as the hospital's Director of Research. He says, "The most common surgical treatment for Stress Urinary Incontinence [SUI] is called a vaginal sling, which is a surgery that takes about thirty to forty-five minutes in the operating room."

When a woman with SUI coughs, bends, or laughs, her urethra moves, allowing urine to leak. A vaginal sling procedure involves placing a little strip of surgical mesh underneath the urethra to support it so that the urethra can't move out of place. There are different approaches to this procedure, but the basic concept remains the same. "The vagina really doesn't have pain fibers, so it's almost a painless surgery," says Peters, adding that there have been big advances in the last half a dozen years regarding SUI surgeries.

Although the vaginal sling procedure is done in a hospital operating room as a day surgery, Peters says that urologists have discussed doing studies to see if it could be done as an in-office procedure.

Because the vaginal sling procedure is so easy, another procedure that has been used for years to treat bladder leakage—the open bladder suspension procedure—has really fallen out of favor among both surgeons and patients. Peters adds, "I would say the vast majority of surgical treatments for SUI are these vaginal slings with the piece of mesh."

As with other medical specialties, there are always advances being made in urology and, in particular, the surgical treatment of bladder leakage. One such advance, which is being studied at Beaumont Hospital in the first trial of its kind in the United States, allows a woman to use her own stem cells to treat her bladder leakage. The procedure studied in the trial involves taking a tiny amount of tissue from a patient's thigh muscle. The tissue is sent to a lab, where the cells are grown into a larger sample. The cells are then sent back to the doctor, who injects them into the patient's urinary sphincter [the muscle that helps control the release of urine]. "What we hope to see is that it's going to grow the sphincter and allow the continence to return," says Peters. "There was just recently a study in Canada, which showed a good success rate. I think that certainly is something that may have potential for the future for stress incontinence. It's something that we're doing with a little local anesthetic in the office. I'm very excited about the study."

Another minimally invasive treatment for bladder leakage is the use of bulking agents, which have long been used to increase the size of the urinary sphincter. By injecting collagen into the sphincter, the size of the muscle is increased, thereby causing it to close more tightly and stop the leakage of urine. "The problem with bulking agents in the past has always been that they tend to work for a while, but then they tend to fail," notes Peters. He says that while he still uses bulking agents for certain patients, it's not his preferred option for treating bladder leakage. Although he doesn't see any advances in bulking agents on the horizon, what he does see is the possibility that the treatment being studied in the adult stem cell trial could replace the need for bulking agents.

For more information about Dr. Peters or Beaumont Hospital, visit the following Web resources:

Beaumont Comprehensive Urology Center www.urologist.org
Beaumont Hospital, Royal Oak Campus www.beaumonthospitals.com/Locations-and-Visitor-Information-Royal-Oak-Hospital