Non-surgical Aesthetic treatments For Urinary Incontinence

Menopause: Menopause can cause the pelvic floor muscle to weaken and the bladder loses its elasticity.

Chronic cough: By causing the pelvic floor muscle to relax momentarily and leakage of urine.

Chronic constipation: An overfull bowel (due to constipation) can press on the bladder, reducing the amount of urine it can hold.

Gynaecological factors: Like uterovaginal prolapse (sagging) or pressure by large tumours like fibromyomas or an ovarian cyst or in distortion caused by endometriosis.

Urinary Incontinence: Who should do your assessment?

It is prudent to identify the type/cause of urinary incontinence accurately to devise a suitable treatment plan. The assessment ideally should be carried out by a highly qualified and experienced OBandGY Specialist/Consultant who is knowledgeable on the standards of ICS and able to have a holistic and specialized "Uro-Gynae Evaluation", select cases' suitability to a matching procedure(s) and personalise the treatment plan to maximise the success rate.

Urinary Incontinence: What does assessment entail?

Taking full medical history: Demographic, Obstetric, Gynaecological including info on lifestyle or daily habits, etc.

Urine analysis: It is an office procedure or at the lab where a mid-stream urine sample is checked for signs of infection, traces of blood or other abnormalities.

Bladder diary: A record of how much you drink and urinate for several days and whether you have the urge to urinate.

Post-void residual measurement: Using an ultrasound machine to measure the amount (volume) of urine leftover remaining in your bladder following urination.

Cystometry, Uroflowmetry, Urodynamic studies: That is the bladder function tests using very fine catheters threaded into the urine tube to measure the pressure changes inside the bladder wall and interpreted against the changes in pressure inside the tammy (intraabdominal pressure) gauged by another fine catheter that is passed through the back passage opening. The graphs of both pressures are recorded during urine provocation tests and during passing urine.

(B) Medicinal treatment

Anticholinergics are the most common OAB medications. You take them by mouth at least once a day.

Topical Oestrogen; vaginal rings, tablets, or creams are also prescribed to treat women's OAB symptoms.

(C) Surgical interventions: As indicated, advised and performed by an experienced Gynaecologist after full clinical assessment and counselling about the success rate, risks, potential complications, and recurrence rate.

Prolapse treatment procedures include anterior colporrhaphy, posterior colporrhaphy or colpoperineorrhaphy, autologous sling grafts (artificial mesh procedures are prohibited), laparoscopic colposuspension, (vaginoplasty) with or without hysterectomy, others like Clam’s procedure, etc.

(D) Minimally invasive/office procedures: Cystoscopic Neurotoxin injection (Botulinum A) ^3-7 into the bladder muscle wall [intravesical] partially paralyzes it to ease overactivity but leaves enough control. Also, can use an injection of sclerotic fillers into the bladder neck.

(E) Non-surgical options: An initial full Gynaecological assessment by an expert Gynaecologist is crucial for case selection. These non-surgical procedures are strongly advised and recommended to be performed by the efficient Gynaecologist who knows best in the microanatomy and physiology of this feminine area. Hence, the experienced Gynaecologist knows best; capable to select the ideal procedure to achieve the highest possible success rate according to individual variations and circumstances.

1 - Non-Surgical Aesthetic/Regenerative Gynaecology Procedures: What are they?

i-Laser treatment ^8-10

Laser therapy has been proven to be successful in treating disorders affected by collagen damage by promoting the synthesis of collagen in the connective supporting endopelvic fascia/tissues around the bladder outlet with an excellent safety record.

Laser therapy stimulates blood flow to the affected areas, bringing healing and rejuvenation to the pelvic floor muscle, vaginal walls and urethra. The increased blood flow and better tissue tone lead to better urinary function.

A laser beam is aimed at the area to stimulate the body’s healing repose and production of collagen and elastin which are essential components of healthy cells.

ii-Radiofrequency treatment ^{11, 12,}

Temperature-controlled radiofrequency generating machines are used for the treatment of mild to moderate urinary incontinence (as selected by an experienced Gynaecologist) that help tighten the underlying connective and supportive tissues of the vagina, urethra and tissues beneath the bladder.

iii-Platelet Rich Plasma injection ^13-15

The autologous platelet-rich plasma (PRP) whether the one known as an “O” Shot or Urethral PRP injection is safe and effective in increasing urethral resistance and improving SUI. PRP could be an alternative treatment modality for male and female patients with moderate SUI due to non-neurogenic causes.

iv-Other Autologous Cell grafts: Like Stem Cell Therapy and ESWT ^16-20

ADSC: adipose-derived stem cell or BMSCs: bone marrow-derived mesenchymal stem cell or human umbilical cord blood stem cells (HUCBs) and total nucleated cells (TNCs) are directly and locally injected into the urethra/ bladder neck in SUI. Studies showed that the median improvement rate of intrinsic sphincter deficiency after ADSCs, MDSCs, TNCs, and HUCBs injections were 88%, 77%, 89%, and 36% (improvement rate: 1-2 pads) at a mean (range) follow-up of 6 (1-72) months. The cell sources, methods of cell processing, cell number, and implantation techniques differed considerably between studies. Most of the periurethral injections were at the 3, 5, 7, and 9 o'clock positions and for submucosa were at the 4, 6, and 8 o'clock positions. No significant postoperative complications were reported.

Recently ESWT has been found very useful in the treatment of intractable cases of Interstitial Cystitis in both genders.

All references can be found here.