Voiding Dysfunction Treatments

Voiding dysfunction treatments help control the bladder. They include biofeedback, medications, peri-urethral injections, electrical stimulation (Interstim implant) and surgery.

Biofeedback
Biofeedback involves the monitoring of a learned or naturally occurring physiological process in a way that information about the process can be given back to the patient. In patients with urinary incontinence and an overactive bladder, biofeedback couples the physiological recruitment of the proper muscle groups in pelvic floor exercises with observable stimuli, typically visual or audio cues. In most cases, either vaginal, perineal or rectal electromyographic monitoring can be used to detect muscle activity, which is reported back to the patient, making them aware of the success of the exercise.
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Medications
Most drugs used in the treatment of urinary incontinence and voiding dysfunction in women modulate neuromuscular transmission in the urethra and bladder. Pharmacotherapy is the mainstay of treatment for overactive bladder. Although several different antimuscarinic medications are available for the treatment of overactive bladder, most have similar efficacy and tolerability. Pharmacotherapy has a limited role in the management of stress incontinence and voiding dysfunction in women. Newer drugs that target different mechanisms of action are being developed for the treatment of urinary incontinence and voiding dysfunction in women.
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Peri-Urethral Injections
Collagen periurethral injection is a procedure in which collagen is injected around the urethra and bladder neck as a treatment for stress incontinence in women. The injection of bulking agents such as collagen around the urethra aims to improve the lost support of the bladder and urethra.

The collagen periurethral injection procedure is quick, and usually over within 15–20 minutes. No incisions are made, meaning that it can be carried out using a local anesthetic or a regional anesthetic such as an epidural. The surgeon uses a fine fiber-optic cystoscope to examine the inside of the urethra and bladder, and then inserts a fine needle to inject the collagen. Usually three injections are made around the urethra. The exact amount of collagen used depends on how much closure the urethra requires.
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Electrical Stimulation
Mild electrical pulses can be used to stimulate the nerves that control the bladder and sphincter muscles. Depending on which nerves the doctor plans to treat, these pulses can be given through the vagina or anus, or by using patches on the skin. Another method is a minor surgical procedure to place the electric wire near the tailbone. This procedure involves two steps. First, the wire is placed under the skin and connected to a temporary stimulator, which you carry with you for several days. If your condition improves during this trial period, then the wire is placed next to the tailbone and attached to a permanent stimulator under your skin.
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Surgery
Physicians may address stress incontinence surgically through one of the following methods:

  • Implanting a suburethral sling
  • Implanting an artificial sphincter device
  • Cryoplasty
  • Reconstructing and lifting the bladder when it has fallen
  • Closing the bladder neck

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Definitions