Incontinence
Urinary incontinence can be an embarrassing condition that affects the quality of life of millions of people worldwide.
Mr Malde is a urologist with specialist expertise in the investigation and treatment of lower urinary tract symptoms and urine leakage (incontinence) in both men and women.
Specialist appointments for comprehensive investigation and treatment can be booked at any of his private urology clinics near you covering:
Overactive bladder
What is overactive bladder (OAB)?
Overactive bladder (OAB) is a common condition that affects millions of men and women worldwide. The commonest symptom is a sudden urge to urinate that you cannot control and this may result in the leakage of urine (urge incontinence). Having to pass urine more frequently during the day or night are also symptoms of OAB.
OAB can disrupt your work, social life and sleep and can be extremely distressing.
What causes OAB?
Although the cause is unknown in the majority of cases, a number of conditions can lead to symptoms of OAB. These include:
Conditions affecting the nerve supply to the bladder (such as multiple sclerosis or Parkinson’s disease)
Certain medications
Diabetes
Bladder tumours
An enlarged prostate gland in men
Excess intake of caffeine or alcohol
Incomplete bladder emptying
Previous surgical procedures or radiotherapy treatment
If these symptoms are affecting your quality of life or leading to anxiety or depression, then you should seek medical advice.
Mr Malde offers specialist appointments for further investigation and treatment of OAB in both males and females in his private urology clinics across London.
How can OAB be treated?
Conservative measures:
Fluid modification – reducing the amount of caffeine and alcohol that you drink may help improve your symptoms and reducing your fluid intake in the evenings may reduce nocturia
Bladder training – the aim of bladder training is to slowly train the bladder to hold larger and larger volumes of urine, thereby improving the symptoms of OAB. We will explain how to do bladder training at your consultation
Pelvic floor exercises with a trained physiotherapist
Oral medications:
If there is not enough improvement with bladder training alone, then we may recommend medications to relax your bladder
Although they can be quite effective, they may result in side effects and we will discuss these with you at your consultation
Bladder botox injections:
This procedure may be considered if your symptoms are still bothersome despite oral medications
It involves injecting botulinum toxin A (botox) into your bladder to dampen down the overactive contractions
It is performed under local anaesthetic through a small, flexible telescope (cystoscopy) that is passed through your water pipe (urethra) and into your bladder
It will take 5-10 minutes to perform and you can go home the same day
Botox injections are effective in 7 out of 10 people (70%)
The effects typically last between 6 and 12 months and then need to be repeated
In a small number of people, the botox injections may make it harder for your bladder to empty and so you may need to pass a catheter tube into your bladder in order to get it fully empty (self-catheterisation)
Sacral nerve stimulation (sacral neuromodulation):
This procedure may be considered if your symptoms are still bothersome despite oral medications and you do not wish to undergo botox injections
It involves inserting a small pacemaker-like device under the skin of your lower back to send electrical signals to the nerves that control your bladder
The treatment involves two separate operations a few weeks apart. The first stage involves inserting a temporary test wire to the nerves that supply your bladder to see if the treatment will work well for you. The second stage involves inserting a permanent device under the skin of your lower back if you have found the test phase to be effective in treating your symptoms
Sacral neuromodulation is effective in 7 out of 10 people (70%)
Percutaneous tibial nerve stimulation:
This is another way to stimulate the nerves controlling the bladder.
It is performed under local anaesthetic and involves stimulation of nerves in your ankle, which then stimulate the nerves controlling your bladder.
Surgery:
If the above measures are not successful, then surgery is sometimes recommended to treat OAB syndrome
Augmentation ‘clam’ cystoplasty involves increasing the size of your bladder using a small piece of your intestine (bowel). This is major surgery and we will discuss this in more detail with you at your consultation, if appropriate
How we can help you
Mr Malde is a leading specialist in the management of OAB in men and women, and offers a comprehensive service to investigate and treat this condition.
A detailed medical history will be followed by a physical examination of the external genitalia and nervous system. Further tests are aimed at ruling-out other causes for OAB symptoms and consist of blood tests to check for diabetes or kidney disease, urine tests to check for infection or blood, review of your bladder diary, a test of your urine flow and bladder emptying, and specialist urodynamic studies to evaluate the function of the bladder and urethra (and prostate in men). Further scans or direct inspection of the bladder with a flexible telescope (cystoscopy) will be carried out if required.
Mr Malde offers the full range of treatment options and procedures for this condition. This includes behavioural and fluid advice, bladder training and pelvic floor exercises, oral medications, bladder botox injections, sacral nerve stimulation (sacral neuromodulation) and augmentation (‘clam’) cystoplasty.
Specialist appointments can be booked at any of his private urology clinics across London.
Stress urinary incontinence
What is stress urinary incontinence?
Stress urinary incontinence is leakage of urine when you increase the pressure on your bladder, such as by laughing, coughing, sneezing or exercising. It is the most common type of incontinence in women and it affects one in five women over the age of 40. It can also occur in men after prostate surgery or radiotherapy treatment for prostate cancer.
What causes stress urinary incontinence?
Stress urinary incontinence occurs when the pelvic floor muscles that support the bladder are weakened. This commonly happens as a result of childbirth but a number of other factors can increase the chances of stress urinary incontinence:
Increasing age
Overweight
Multiple vaginal deliveries
Post-menopausal
In men after prostate operations
How can stress urinary incontinence be treated?
Stress urinary incontinence can be treated with conservative measures, medication or surgical treatment.
Conservative measures:
The first-line treatment option for stress urinary incontinence is pelvic floor muscle strengthening exercises supervised by a specialist pelvic floor physiotherapist. This can improve incontinence in 6 out of 10 women
Weight loss has been shown to significantly improve stress urinary incontinence symptoms
Topical oestrogen supplements can be applied to the vagina in post-menopausal women and has been shown to improve incontinence symptoms
Medication:
Duloxetine, an anti-depressant, has also been found to be effective in improving symptoms of stress urinary incontinence in women. However, it does lead to side effects such as nausea and vomiting. It is generally only recommended for women who do not wish to undergo surgery or in women who have health problems that mean they are not suitable for surgery
Surgery:
A number of surgical procedures exist for the treatment of stress urinary incontinence that has not improved with pelvic floor muscle exercises. Mr Malde will discuss the best option for your specific type of stress urinary incontinence at your consultation. Options include:
Sling procedures using synthetic materials (tension-free vaginal tape or transobturator tape). This is a relatively minor procedure with a short recovery time. A synthetic sling is placed under your water pipe (urethra) to provide support to your urethra when you cough or exercise, thereby stopping your incontinence. Incontinence improves in approximately 8 out of 10 women. However, a small number of women develop complications related to the tape such as chronic pain and erosion (damage to your water pipe or bladder by the tape)
Sling procedures using natural tissue (autologous fascial slings). This is similar to the synthetic sling procedure but uses your own body tissue as the sling instead of synthetic material. The sling is made from the tissue that surrounds your abdomen muscles (rectus fascia) and so the surgery involves making a small bikini line cut in your lower abdomen. The recovery time is around six weeks and incontinence improves in approximately 8 out of 10 women. The risks of chronic pain or erosion are extremely rare but some women may find it harder to empty their bladder after the operation and may need to pass a small tube into their bladder to empty it (self-catheterisation)
Colposuspension. This is an open operation done through a bikini line cut in your lower abdomen. Stitches are placed either side of the bladder to provide extra support when you cough or exercise. Incontinence improves in approximately 8 out of 10 women and the recovery time is around six weeks
Periurethral bulking agent injections. This involves injecting a bulking agent into your water pipe (urethra) using a telescope (cystoscopy). The procedure takes 10 minutes and you can go home the same day. The risk of complications is low. However, repeat injections may be needed and success rates are lower than the other options
How we can help you
Mr Malde is an expert in the investigation and treatment of stress urinary incontinence in men and women. Specialist appointments can be booked in any of his private urology clinics across London.
Post-prostatectomy incontinence
What is post-prostatectomy incontinence?
This is the leakage of urine that happens as a result of prostate surgery or radiotherapy treatment for prostate cancer. It is not uncommon and occurs in around 1 in 10 men who have surgery for prostate cancer.
What causes post-prostatectomy incontinence?
Leakage of urine can result from damage to the blood or nerve supply to the external sphincter muscle that normally allows you to control your urine or due to direct injury to this muscle during surgery. This will lead to symptoms of stress urinary incontinence.
Alternatively, the sphincter muscle may not be affected and the leakage may be due to urge incontinence.
It is therefore important to undergo a detailed evaluation to work out the cause of your specific type of leakage.
Mr Malde is experienced in the treatment of incontinence following prostate surgery and will provide the best treatment for your specific symptoms. To make an enquiry or to book an appointment, contact us.
How can post-prostatectomy incontinence be treated?
The first-line treatment for stress urinary incontinence after prostate surgery is pelvic floor muscle strengthening exercises supervised by a specialist pelvic floor physiotherapist. This may improve your leakage enough to avoid further surgery.
If this does not improve things, then the further treatment recommended to you will depend on the amount of urine you leak and the cause of your incontinence. There are two surgical procedures that are used to treat post-prostatectomy incontinence:
Artificial urinary sphincter. This involves surgery to insert an artificial valve around your water pipe (urethra). It is made of three parts:
A cuff that fits around your water pipe (urethra) which squeezes it to keep it shut and prevent leakage
A balloon that sits in your lower abdomen
A pump in your scrotum that allows you to control when you want to urinate
When you need to pass urine you will need to squeeze the pump in your scrotum. This will open the cuff around your urethra and allow you to pass urine. The cuff then slowly re-fills and squeezes the urethra closed after approximately one minute, preventing urine leakage.
Approximately 9 out of 10 men will be extremely happy with the results of the artificial urinary sphincter surgery.
As with all surgical procedures, there are some risks of having an artificial urinary sphincter inserted such as: infection of the device, erosion (damage to your water pipe caused by the cuff) or parts of the device breaking over time and needing to be replaced.
Male sling. This involves surgery to place a synthetic sling under your water pipe (urethra). This sling provides extra support to your sphincter muscle when you cough or exercise, thereby improving your urine leakage.
The male sling works well for less severe degrees of leakage and approximately 7 out of 10 men will find that their leakage improves with this surgery.
We will discuss the best option for you at your consultation.
Mr Malde offers specialist appointments for further investigation and treatment at his private urology clinics across London.
How we can help you
Mr Malde is experienced in providing the best investigation and treatments for post-prostatectomy incontinence. He will perform a detailed history and physical examination, followed by specialist urodynamic tests and a telescopic inspection of your sphincter and bladder (cystoscopy). Mr Malde will assess your level of leakage over a 24 hour period and discuss the best treatment options in your specific case. He offers the best surgical treatment options for post-prostatectomy incontinence – the artificial urinary sphincter and the male sling.