Harry W. Johnson Jr., M.D.
A cough, sneeze or even laughter may cause an involuntary loss of urine in women with stress incontinence. Millions of women, as well as men in this country are suffering silently from incontinence. They are too embarrassed to discuss the problem, even though there are more treatment options for urinary incontinence today than ever before. That's according to Harry Johnson, M.D., director of the division of urogynecology and pelvic reconstructive surgery at the University of Maryland Medical Center.
"Many people learn to live with incontinence, despite the fact they can receive significant relief from this debilitating condition. It does not just affect older women. Women in their 20's and men, too, can suffer from incontinence," says Dr. Johnson, an associate professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine.
While there are non-surgical treatment options like muscle strengthening exercises, bladder training and medications, surgery may sometimes be the best option to improve or cure incontinence, especially if the condition is caused by a change in the bladder's position. Minimally invasive surgical procedures are often used to treat the most common type of incontinence, stress urinary incontinence, resulting from inadequate bladder support from the pelvic muscles or a weak or damaged urethra. Childbirth can also predispose a woman to urinary stress incontinence. There are two "gold-standard" surgical therapies for women with stress incontinence - the Burch colposuspension and the pubovaginal sling. Both have an 80 to 90 percent success rate.
Now, the University of Maryland is one of nine national centers participating in a NIH-funded national study to determine, for the first time, which of these two surgical treatments provides the best results. "Most surgeons do the procedure they're comfortable with. This study is designed to find out which procedure is optimal for both patients and surgeons," explains Dr. Johnson. He and urologist Dr. Toby Chai are the principal investigators for the Urinary Incontinence Treatment Network study at the University of Maryland.
In the Burch procedure, the surgeon secures sutures to thick bands of vaginal fascia tissue running along the urethra to stabilize the bladder neck. The sling procedure uses a small strip of the patient's own fascial tissue to support the urethra in a more anatomic position. The fascia is surgically placed under the urethra and bladder neck like a hammock, then secured with sutures to the lower abdominal wall.
Surgeons in the study are certified to perform the two procedures in a standardized way and are prepared to perform either procedure. Patients are followed for a minimum of two years. They are surveyed and examined to evaluate the success of the surgery.
The University of Maryland Continence Center specializes in the diagnosis, treatment and rehabilitation of patients with urinary incontinence. The Center also specializes in pelvic organ prolapse, fistulas and congenital anomalies. Dr. Johnson says, "We are helping patients suffering from pelvic floor dysfunction overcome their disorder, allowing them to return to normal, active lives."