New Surgeries & Medical Therapies
At the Institute for Female Pelvic Medicine & Reconstructive Surgery one of our primary objectives is to keep abreast of the most current treatments and therapies related to female urinary incontinence and pelvic floor disorders.
New surgery for stress incontinence
Physicians at the Institute for Female Pelvic Medicine and Reconstructive Surgery are the first in world to perform a new FDA-approved technique to correct urinary stress incontinence. The procedure uses trans-vaginal tape called “TVT Tension-free Support” with the new placement device, TVT Secur. The technique is performed without external skin incisions and clinical trials have shown virtually no postoperative pain.
Stress urinary incontinence is a condition that affects more than 19 million women in the United States alone. Female stress urinary incontinence is caused predominantly by an improperly functioning urethra; it is not a problem of the bladder. Normally, the urethra, when properly supported by strong pelvic floor muscles and healthy connective tissue, maintains a tight seal to prevent involuntary urine loss. When a woman suffers from stress urinary incontinence, weakened muscle and pelvic tissue do not support the urethra adequately. As a result, the urethra does not maintain a tight seal during exercise, sneezing, coughing or other movement and urine escapes.
TVT Tension-free Support combines the use of safe material, PROLENE polypropylene mesh and a variation of a traditional operation known as a sling procedure to correct stress urinary incontinence. The PROLENE mesh is inserted through the vagina and positioned underneath the urethra to create a supportive sling. No traditional surgical anchors are required. As the tape passes through several pelvic tissue layers, friction is created, which secures the tape in place. Since the procedure is usually performed under local anesthesia with IV sedation, any necessary adjustments to the mesh tape can be made intra-operatively utilizing a cough test, which improves placement of the sling and the success rate. Over time, the natural in-growth of tissue into the mesh further secures the tape.
During movement or exercise, the mesh tape loosely supports the middle of the urethra allowing it to maintain its seal to prevent urine loss. The tape, therefore, uniquely provides support only when needed and without any unnecessary tension on the urethra (tension-free). This reduces the need for catheterization after surgery.
The procedure can be completed within 15 minutes under local anesthesia, and patients may return home the same day. TVT Tension-free Support offers short recovery time with minimal pain. In contrast, many surgical treatments currently in use for treating stress urinary incontinence involve general anesthesia, extensive surgery and a lengthy recuperation.
World-Class Care for Women
For women with pelvic support problems, a world-class solution is offered at IFPM by the first surgeon in the world to perform it. The minimally invasive procedure known as PROLIFT employs a specially designed supportive mesh placed in the pelvis. Considered the most advanced pelvic floor procedure for pelvic organ prolapse, it is complete in less than half the time of traditional surgery. Patients experience less pain, fewer complications, greater success and go home the next day.
Dr. Vincent Lucente, medical director at The Institute for Female Pelvic Medicine & Reconstructive Surgery was the first surgeon in the world to perform PROLIFT. Parnter Miles Murphy, MD and Heather van Raalte also perform the procedure.
“PROLIFT employs synthetic mesh to support the pelvic organs that have dropped out of their normal position,” says Dr. Lucente. “The synthetic mesh is specially designed for transvaginal placement utilizing a minimally invasive technique. What’s more – the mesh offers promise of life-long durability, the best news toward a permanent solution.”
This procedure offers most women the additional benefit of returning to their normal daily activities within days, according to Dr. Lucente. “This procedure not only offers hope for permanent results, but a greatly improved quality of life,” he says.
Two new treatments now available for Over Active Bladder
Over Active Bladder (OAB) is a medical condition that causes the bladder muscle (known as the detrusor muscle) to contract while the bladder is filling with urine, rather than when the bladder is full. This results in a patient experiencing urgency (an immediate and strong sense to urinate), frequency (the need to frequently go to the bathroom), and for many, urge incontinence (an involuntary loss of urine). Although prevalence increases with age, the problem affects people of all ages. People with OAB often limit travel, social and even work activities to avoid potentially embarrassing episodes that can occur with this condition.
Vesicare® (solifenacin succinate) tablets, a new prescription medication for the treatment of overactive bladder (OAB), is now available at the Institute.
Vesicare was approved by the U.S. Food and Drug Administration (FDA) in November 2004, and was found to significantly reduce the number of incontinence episodes for patients over 12-weeks. The Institute participated in the clinical studies involving more than 3,000 patients nationwide with symptoms of urgency, frequency and/or urge incontinence. Once-daily Vesicare 5 mg and 10 mg showed statistically and clinically significant improvement in all major symptoms of OAB during a 12-week study period. For more information visit www.yamanouchiamerica.com
Enablex® (darifenacin) extended-release tablets (7.5mg and 15mg) is now available by prescription for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency and frequency. Enablex, a once-daily medication, works by blocking the M3 receptor, which is primarily responsible for bladder muscle contraction.
Enablex has a unique M3 profile and is a potent muscarinic receptor antagonist that helps reduce incontinence episodes, increases the amount of urine the bladder can hold, reduces the frequency of urination episodes, and decreases the pressure or urgency associated with the urge to urinate. In total, Enablex has been studied in 98 clinical trials involving more than 10,000 people.
For more information visit www.novartis.com
Dr. Lucente first surgeon in the United Sates to perform new incontinence surgery
Dr. Lucente (l) with Drs Rogers and DeLeval (center) in Liege, Belgium.
Dr. Lucetne (R) performing surgery with Dr. DeLeval at Leige University Hospital, Belgium
On December 29, 2003, Dr. Lucente performed the first TVT Obturator surgery for stress urinary incontinence in the United States. Studied in over 200 patients in Europe, this new surgical procedure was invented by Jean DeLeval, professor at the University of Liege’s Medicine Faculty and urologist at Liege University Hospital, Belgium. In the Fall of 2003 Dr. Lucente trained with Dr. DeLeval.
In early 2004, Dr. Lucente began live telesugery broadcasts to teach physician across the United States this new surgery. To date over a thousand physicians have been educated. In May over 500 physicians viewed a live telesurgery at The American College of Obstetrics and Gynecology Annual Clinical Meeting in Philadelphia, PA
This new surgery refines the traditional TVT, now considered a gold-standard in stress incontinence repair, by adding an obturator approach that further optimizes surgical safety. This technique involves passage of the instruments and the supportive tape (mesh) through a small opening along sid of the pelvic bone that avoids injury to the bladder and intestines.
The surgical procedure uses safe material, PROLENE polypropylene mesh, and a variation of a traditional operation known as a sling procedure to correct stress urinary incontinence. The PROLENE mesh is inserted through the vagina and positioned without tension underneath the urethra, creating a supportive sling.
During movement or exercise, the mesh supports the urethra, allowing it to maintain its seal to prevent urine loss. The tape, therefore, uniquely provides support only when needed, without any unnecessary tension on the urethra (tension-free).
In contrast to traditional, “open” surgeries, this procedure can be completed within 30 minutes and can be performed under local anesthesia in an outpatient setting. Recovery time is short and most patients can go back to their routines in just a few days.
What is OXYTROL?
One of the conditions we treat is Overactive Bladder (OAB). Approximately 33 million people in the US suffer from OAB. OAB makes it hard for you to control your bladder. The most common symptoms are urinary frequency (voiding more than 6-8 times in 24 hours) and urgency (strong, immediate sensation to void that you cannot suppress). OAB can also lead to accidental urine loss (incontinence, leaking or wetting oneself) before you reach the toilet.
We recently had the opportunity to be the first to introduce to our patients a revolutionary new skin patch to treat overactive bladder called OXYTROL. Oxytrol was approved by the FDA this year and is now available as part of our therapies.
OXYTROL is the first and only transdermal system (skin patch) to treat OAB. OXYTROL's transdermal delivery system delivers oxybutynin, a medication widely accepted and prescribed in oral formulations for over the past 25 years, into the bloodstream. Since the drug is delivered into the bloodstream through your skin, the initial metabolism process in the liver and the stomach as seen with oral therapies is avoided. This helps alleviate side effects.
OXYTROL is a thin, flexible and clear patch that is applied to the abdomen, hip or buttock twice weekly and provides continuous and consistent delivery of oxybutynin over a three to four day interval. OXYTROL can be worn during normal activities, including bathing, swimming, showering, or exercising. OXYTROL offers OAB patients continuous effective bladder control with some of the side effects, such as dry mouth and constipation encountered with and oral formulation. In most patients these side effects however are not a troublesome.
For more detailed information visit www.oxytrol.com
New options available at the Institute for Overactive Bladder
The Institute for Female Pelvic Medicine & Reconstructive Surgery is now offering patients a newly approved drug by the U.S. Food and Drug Administration (FDA) for the treatment of the troublesome symptoms of urinary urgency and frequency.
SANCTURA, belongs to a class of anticholinergic compounds known as muscarinic receptor antagonists. These compounds relax smooth muscle tissue found in the bladder, thus decreasing bladder contractions. Involuntary contractions of bladder muscle is believed to be the cause of overactive bladder symptoms.
The growing numbers of people affected by overactive bladder will benefit from the introduction of this new drug and it offers a new treatment option that has been shown to be safe and effective in patients with this debilitating condition."
For more information go to www.sanctura.com