Vincent Lucente, MD, F.A.C.O.G., is a board
certified obstetrician and gynecologist and a fellowship trained urogynecologist
and reconstructive pelvic surgeon. Dr. Lucente is Chief of the Section
of Female Pelvic Medicine and Reconstructive Surgery at Abington Memorial
Hospital, Associate Professor of Obstetrics & Gynecology at Pennsylvania
University College of Medicine/Hershey Medical Center, and Medical Director
for the Institute for Female Pelvic Medicine and Reconstructive Surgery.
Dr. Lucente founded the Institute in 2001 as a center of excellence for
female pelvic floor disorders that integrates medical training, innovative
clinical research and service oriented patient care. Dr. Lucente is an
avid researcher with over 12 years of experience in surgical research,
medical device, and pharmaceutical clinical trials in the fields of both
gynecology and urogynecology. He has published numerous articles in peer
review journals and authored several textbook chapters. www.fpminstitute.com/
Radio Frequency Bladder Neck Suspension: A Treatment for Genuine Stress
The third in a three-part series on surgical treatment options for Stress
Urinary Incontinence (SUI)
If you suffer from stress urinary incontinence (SUI)
you are not alone. This condition affects more than 16.5 million women in the
United States and these numbers are growing each year. More often than not,
women who suffer from this condition quietly cope, while their quality of life
slowly deteriorates. It has been said that incontinence doesn't kill you ...it
just takes your life away. Fortunately surgical treatment is now available
through several minimally invasive techniques.
SUI is not truly a problem of the bladder; it is actually caused by an improperly
functioning urethra. The urethra is the thin, muscular, tube-like structure
that runs from the bladder to the outside of your body where urine is expelled.
Normally, a healthy urethra, when properly supported by strong pelvic floor
muscles and intact connective tissue, maintains a "water-tight" seal to prevent
involuntary loss of urine during physical stress (coughing, sneezing, and lifting).
When a woman suffers from SUI, most often weakened muscles and tissues in the
pelvic floor (caused by factors such as childbirth, loss of estrogen and repetitive
pelvic muscle straining) are unable to support the urethra in its correct position.
When sudden abdominal pressure, such as that from a cough or sneeze, is exerted
on the bladder, the urethra cannot remain closed and urine escapes.
The urethra is primarily supported by the vagina.
It lies atop of the vagina which acts like a hammock, much like the one you
find in the backyard. The urethra lies on top of this hammock and is supported,
like you would be if you were lounging comfortably on the hammock. Two things
provide support while you lie on the hammock: the ropes that tie it to the base
(connective tissue) and the strength of the actual canvas (vaginal wall muscle).
When SUI occurs this hammock effect is weakened and can no longer offer the
proper support. This results in urine leakage during physical activity such
as running, jumping, sneezing or coughing.
In parts one and two of this series we reviewed a
minimally invasive surgical approach for treating SUI called a trans-vaginal
tape (TVT) procedure that essentially creates a new hammock for the urethra
and a suspension via a laparoscopic burch colposuspension, which you can think
of tying "new ropes" to the existing hammock. Part three will discuss a relatively
new procedure called radio frequency bladder neck suspension, which basically
causes the hammock to heat shrink.
What is Radio Frequency Bladder Neck Suspension?
Radio frequency bladder neck suspension is a minimally
invasive procedure that applies precisely controlled, low-power radio frequency
energy to small, precise areas of the supporting tissue of the pelvic floor
where continence is controlled. As the pelvic tissue is heated by this energy,
it shrinks and stiffens. The pelvic floor then stabilizes during the normal
healing process. Once stabilized, the pelvic tissue is once again able to properly
support the urethra allowing it to maintain that "water-tight" seal during stress
activities such as coughing or sneezing.
The SURx System
Radio frequency tissue heating has been used in medicine
for more than 100 years and is currently used in the treatment of a variety
of medical conditions such as back pain, shoulder problems, GI disorders, prostate
disease and others. It is only recently that this mechanism has been applied
to incontinence using the SURx system. This system is the bipolar radio frequency
device applicator and the generator that is used in the procedure. The procedure
can be performed laparoscopically or vaginally.
Am I a Candidate for a SURx Procedure?
The SURx procedure is most recommended for women with
mild genuine stress incontinence where this is the first course of surgical
intervention. It is also recommended for women desiring future pregnancy.
Only a complete physical examination and consultation with your physician can
determine if a radio frequency bladder neck suspension is right for you.
What Does Recovery Involve?
After the surgery, which is done in an outpatient setting, you will go home
in a few hours. Many patients return to normal daily living activities within
a few days and return to non-laborious work in three weeks. During this time
there should be very little interference with daily activities but you will
have to avoid strenuous physical activity such as exercise, lifting and intercourse.
Tissue remodeling occurs during these several weeks. It is important not to
stress the tissue before the process is completed, which can be up to eight
What is the Success Rate?
Clinical trials have demonstrated a one-year success
rate of 81% and a three-year rate of 65%. This change over time suggests some
patients may need to be retreated.
What are the Risks?
This procedure carries a very low risk of surgical complications. The procedure
leaves no artificial implants or materials such as surgical mesh, cadaver tissue,
bone screws or staples in the body. In addition, postoperative catheterization
is very unlikely.
Today women are unwilling to accept the limitations on their lifestyle caused
by incontinence and are demanding easy, convenient, low-risk treatments. For
some women with this embarrassing and troublesome condition, the SURx procedure
using radio frequency energy may be the right answer.
Click here for Dr. Lucente's first article on minimally invasive surgery
Click here for Dr. Lucente's second article on minimally invasive surgery
For more information on SUI, click here.
Created: 1/8/2004  - Vincent Lucente, M.D., F.A.C.O.G.