FEMALE URINARY INCONTINENCE("Gotta go, Gotta go, Gotta go”)

Female urinary incontinence is a common problem that affects up to 50% of the adult female population. Many women who have bladder leakage put up with the constant discomfort and embarrassment of urinary leakage and avoid seeking treatment. But with the proper medical diagnosis and evaluation, urinary incontinence problems can be treated and significantly improved. The two most common types of urinary incontinence are overactive bladder and ,

I. Overactive Bladder: The common symptoms are bladder urgency, frequency, and nocturia (going to the bathroom multiple times a night). Sometimes the urgency is so strong that you have urge incontinence (involuntary leakage of urine with the desire to urinate). The first option is simple dietary changes, lifestyle improvements, and bladder retraining. Her are some recommendations:

1. Decrease your caffeine intake (e.g. coffee & tea): Slowly taper your caffeine intake so that you are drinking one half to one third the number of cups of coffee a day. Consider changing to decaffeinated coffee. Keep a bladder diary to record the number of times you use the bathroom on a normal caffeine diet versus caffeine-less diet. Also, consider decreasing acidic fluids (e.g. lemonade) and spicy foods. You will see a significant difference.
2. Nocturia (going to the bathroom multiple times a night): A simple alternative is to decrease your fluid intake at night. After dinnertime, drink half the amount of fluids you normally drink and you’ll notice that your visits to the bathroom will be less during the nighttime and you will get more continuous sleep.
3. Bladder Re-training: With overactive bladder, your bladder has spontaneous involuntary bladder spasms but you can retrain your mind to suppress your bladder urgency and frequency sensations. For instance, once you feel the urgency to use the restroom; try to wait another 15 minutes before using the restroom. With much practice, one can suppress the urge sensation from 15 minutes to 30 minutes and perhaps up to one hour.

These various overactive bladder treatment options will help to regain control of bladder function and improve one’s daily activities. If conservative measures fail, then your physician will recommend medications (e.g. Detrol, Ditropan, and others) to improve one’s bladder control. These medications help relax the bladder muscles and suppress the bladder spasms, thereby decreasing the urge sensations. And in the severe cases of refractory overactive bladder in which all medications and conservative bladder retraining methods have failed, then the other options are bladder electrical stimulation like Uroplasty and Interstim (by Medtronics).

II. Stress Urinary Incontinence. Another type of incontinence is stress urinary incontinence. The most common symptoms are leakage of urine with coughing, laughing, or sneezing. At other times, urinary leakage can occur from walking, running, jumping, or lifting things. The recommended first line of urinary incontinence treatment is conservative Kegel exercises. Kegel exercises are pelvic floor muscle exercises that strengthen the muscles around the bladder neck and improve the bladder support, thereby decreasing the amount of leakage.

What happens if I have tried the Kegel exercises for a few months and I still have leaking? The next option is surgical treatment with a TVT (Tension-free Vaginal Tape) sling or TOT (Transobturator Tape) sling. This procedure is a simple outpatient surgical option, with minimal postoperative discomfort, and a quick postoperative recovery (less than one week). The success rate of this bladder sling is excellent with a cure rate of approximately 90-95%.

For more information on urinary incontinence and the various treatment options visit your local laparoscopic gynecology specialist.

What is Laparoscopic Supracervical Hysterectomy?

Laparoscopic supracervical hysterectomy (LSH) is a minimally invasive procedure that was developed during the 1990s as a treatment for abnormal uterine bleeding. The LSH procedure requires a few small 1 centimeter incisions in the abdomen. The body of the uterus is removed, while the cervix is preserved. Also, the ovaries and the tubes can be preserved or removed, depending upon personal preference or ovarian disease. Your gynecological laparoscopic surgeon may recommend saving the ovaries if there is no history of ovarian disease (e.g. recurrent ovarian cysts or masses) and no family history of ovarian cancer.

What are the advantages of a laparoscopic supracervical hysterectomy (LSH) over an abdominal hysterectomy?

· The advantages of a laparoscopic supracervical hysterectomy are:

1. .Smaller incisions (one centimeter in size) which allows for a quicker postoperative recovery with less postoperative pain.
2. Shorter hospital stay (e.g. overnight stay) and patients go home the next day. The patient can return back to normal activities in usually 14-21 days.
3. Preservation of the cervix (which does not disrupt the support of the pelvis tissue and the vaginal cavity). As a result, there is preservation of sexual function.
4. Fewer surgical complications (e.g. less blood loss, decreased risk of infection, and decreased postoperative adhesion formation).

Limitations to the laparoscopic supracervical hysterectomy:

Although most hysterectomies can be performed laparoscopically, there are some limitations. For instance, if the size of the uterus is greater than 22 weeks in size, the fundus (the top) of the uterus reaches above the level of the umbilicus (belly button). When the laparoscopic camera is placed through the umbilicus to visualize the pelvis and the uterus, the visualization is poor and the laparoscopic access is challenging. As a result, it would significantly increase the risk of the surgical procedure. As a result,
your doctor may recommend a total abdominal hysterectomy rather than alaparoscopic hysterectomy simply based on patient surgical safety.

Hysterectomy Recovery

Recovering from a hysterectomy Los Angeles patients should know it takes time. You will stay in the hospital for 1 to 2 days for post-surgery care. Some women stay in the hospital up to 4 days.

Abdominal hysterectomy. During the first 2 to 3 weeks it is important to also get plenty of rest. You will gradually be able to increase your activities. As soon as you feel strong enough, get up and around as much as you can. This helps prevent problems after surgery like blood clots, pneumonia, and gas pains. To help you heal well, avoid lifting more than 20 pounds during the first 4 to 6 weeks after surgery.

Complete recovery usually takes 4 to 8 weeks. Your return to a work routine will depend not only on how quickly you get back your energy and strength but also on how demanding your work is.

Vaginal or laparoscopic hysterectomy. Recovery from a vaginal or laparoscopic hysterectomy takes much less time than from an abdominal surgery. After a routine laparoscopic surgery removing the uterus but not the cervix (laparoscopic supracervical hysterectomy, or LSH), most women are able to return to normal activity in 1 to 2 weeks. About 4 to 6 weeks after the hysterectomy, see your health professional or laparoscopic gynecologic surgeon for a follow-up examination.

How effective is hysterectomy for improving my symptoms?

For women who have severe symptoms and have tried other treatments, hysterectomy may be the next treatment option.

How will I feel emotionally after my hysterectomy?

It is normal to have various concerns when faced with the possibility of having a hysterectomy. A woman's emotions are often based on her beliefs about the importance of her uterus, her fears about her health or personal relationships after a hysterectomy, and concerns about her enjoyment of sexual activities after surgery. If you are considering a hysterectomy, talk with your doctor about your specific fears and anxieties concerning the surgery.

Alternative to Abdominal Hysterectomy?

Many women are faced with the decision to undergo a hysterectomy. Suffering from heavy periods, fibroids, endometriosis, or other types of discomfort can lead a gynecologist to suggest traditional abdominal surgery. What many women don’t know is that there are less invasive options which may be considered.

600,000 hysterectomies are performed in the U.S. annually. While upwards of 80% are abdominal surgeries, they could be done as laparoscopic or vaginal hysterectomies, doctors say. A laparoscopic hysterectomy is much less invasive, meaning that the recovery time is much less than traditional more major surgeries.

A traditional abdominal hysterectomy involves a large incision through the abdominal wall. Much anesthesia and pain medication is needed, and the recovery time is approximately 6 weeks. Some Hysterectomy Los Angeles patients may also look to vaginal or laparoscopic-assisted vaginal hysterectomy (LAVH). Only certain types of women can undergo this type of surgery, but it is also less invasive than the traditional abdominal surgery. Recovery time is approximately 2 weeks.

In Los Angeles laparoscopic hysterectomy, or total laparoscopic hysterectomy as it is often referred, is becoming more and more popular. This type of surgery is done by a specialized and highly trained gynecological laparoscopic surgeon and involves only small “keyhole” incisions in the abdomen. There is minimal pain and recovery time is often less than 2 weeks.

Aside from the quicker and less painful recovery, the advantage of laparoscopic hysterectomy is that nearly all women are candidates. One factor to consider, however, is the cost. Because it takes a much more skilled surgeon, there are less garden-variety gynecologists available to perform the surgery. That is why it is important to find the right surgeon – one who is experienced in several types of laparoscopic and gynecological surgery and is open and honest with you about all the options available.

Hygiene And Urinary Tract Infections After Cystectomy Study

Stockholm, Sweden-based Division of Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet conducted a study to determine whether or not an improved hygiene can lessen the incidence of symptomatic urinary tract infections in patients treated by cystectomy or uterine suspension for urinary bladder cancer.

The study attempted to contact all men and women aged 30-80 years during their follow-up who had undergone cystectomy and gynecological laparoscopic surgery at seven Swedish hospitals.

During a qualitative phase the researchers identified hygienic measures and included them in a study-specific questionnaire. The patients completed the questionnaire at home. Outcome variables were dichotomized and the results presented as relative risks with a 95% confidence interval variable.

The researchers received the questionnaire from 452 (92%) of 491 identified patients. The proportion of patients who had a symptomatic UTI in the previous year was 22% for orthotopic neobladder and cutaneous continent reservoir, and 23% for non-continent urostomy diversion. The relative risk for a UTI was 1.1 (0.5-2.5) for 'never washing hands' before handling with catheters or ostomy material. Patients with diabetes mellitus had a relative risk of 2.1 (1.4-3.2) for having a symptomatic UTI.

The study could not confirm lack of hygiene measures as a cause of UTI for men and women who had a cystectomy Los Angeles sources report. Patients with diabetes mellitus tend to have a greater risk of contracting a UTI. For more information whether in Sweden or Los Angeles laparoscopic hysterectomy patients are encouraged to consult with their local Urogynecology and Laparoscopic Gynecology Specialists to learn more.