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Urology/over active bladder


I'm not sure if this is your expertise but I hope you can help or shine some light on my situation. I am a 65 year old female. About 2 years ago I started with a slight leak. My gyn did a urodynamic test which showed I had stress incontinence.  After talking with my doctor we decided to put a Monarch Urethral sling. This was done in March of 2015. I had no relief from this procedure. My doctor told me to give it some time to work, that it can some times take up to a year. After a year with no relief I went to a new Urologist. I have tried all types of medicines including Vasicare, Toviaz, Myrbetriq and now Oxybutynin 3X a day. Nothing works. I had a spinal procedure done in October to relieve some pressure on my spine which they thought would help but that did not either. Last week I saw a Urogynecologist at the University of Florida in Gainsville  Where the findings were basically at this point there is nothing they can do. That it might have something to do with CSN problem at the spinal cord or rami. Her exact wording was "The only assessment that we don't have at this point is urethral closure pressure(for sphincter deficiency). If it is lowm then urethral bulking could be an option. Given her poor sensation (lack of urge), h/o spinal surgeryand right leg discomfort she may have a CNS problem at the spinal cord or rami. At this point, I don't specifically recommend any additional urogyn evaluation and management.I don't get it. I've been that route and it wasn't fixed. I can't accept that in today's day and age I have to live like this, that there is nothing anyone can do.  Can you suggest anything other then what I have done up to this point?

Thanking you in advance for any information you can provide.


Your situation is complicated by having a surgery on the bladder (the sling) and a spinal procedure.  This makes any further treatment very complicated and difficult.  For example, if you have lost sensation of when you need to void, it can certainly have an adverse effect on urinary function.  Another surgery runs the risk of going from leakage (annoying and inconvenient but not dangerous) to retention (potentially dangerous).  The exact clinical nature of your current leakage problem isn't clear.

Vesicare, Toviaz, Myrbetriq and Oxybutynin essentially do nothing for stress incontinence; they are designed particularly for overactive bladder.  There really is no specific drug intended for and approved for stress incontinence.  he reason they do not work is most likely they are trying to treat the wrong problem.

Urogynecologists are basically gynecologists with extra urology training.  You should see a Urologist with specialty or fellowship training in complicated pelvic floor (bladder) problems.  They are typically found in major University teaching centers, especially in those that also have a Urology residency program.  Good luck.  


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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