Treatment for Incontinence

There are several different kinds of treatment for stress urinary incontinence. Some women wear special pads or diapers. Pelvic floor exercises (called Kegel exercises) can strengthen the muscles that support the bladder and keep the urethral sphincter tightly closed. A small, plastic device, called a pessary, can be placed in the vagina. The pessary pushes against the wall of the vagina, providing extra support for the urethra. For some patients, doctors can use injections of collagen, fat or other substances to bulk up the tissue around the urethra.

When other treatments for stress urinary incontinence fail to provide relief, doctors may recommend surgery. One type of surgery is called the mid-urethral sling. The sling is a thin strip of synthetic or natural material. It's placed under the neck of the bladder through a small incision in the vagina. When pressure is placed on the bladder, the urethra is pushed down against the sling, cutting off the flow of urine out of the bladder.

The sling procedure is very successful for many women. Experts say the procedure has a 90 percent success rate and a long-term cure of 80 to 85 percent. There are some risks to the surgery, like infection and bleeding. Rarely, the urethra is blocked too much, causing an obstruction of urine flow and an over-active bladder.

There are two different techniques for placement of a mid-urethral sling: the retropubic mid-urethral sling (called the TVT) and the transobturator mid-urethral sling (the TVT-O and the Monarc™). Both start with a small incision in the vagina. Then, the TVT procedure pulls the sling through two tiny incisions on top of the pubic bone. The TVT-O and Monarch procedures pull the sling through two incisions in the groin. Both procedures are very successful. But researchers want to know if one is better than the other.

TOMUS (Trial of Mid-Urethral Slings) is a phase IV study to compare the two sling techniques. In addition to comparing the success rates of the treatments, researchers want to follow the women for up to two years to look at complications, quality of life, sexual function, overall satisfaction with the treatment, and need for further treatment after the surgery. For information about the study, log onto to www.uitn.net or call 800-614-9431.