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Urology (Expert Forum)
Urethral dilation - good idea?
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Urethral dilation - good idea?
by Anne, Aug 18, 1999 12:00AM
I am a 35 year old woman in the UK, who has had urge incontinence
since the birth of my second child, by Ceasarean section.
I have had a urodynamics test, the results of which suggested an unstable detrusor. My gynaecologist has tried drugs and bladder training to try to resolve the problem, without any success, and has now referred me to a urologist. The urologist is planning to do a cystoscopy to identify whether I have a motor or sensory problem, and at the same time has suggested a urethral stretch.
I have been looking for information about the urethral stretch (dilation), but can find very little in relation to urge incontinence, only as a cure for a stricture. The little I have found suggests that this procedure is old and has fallen out of favour with most urologists.
I have a few questions that I hope you can answer -
1. Do urologists in the US still use urethral dilation as a cure for urge incontinence?
2. If not, why has it fallen out of favour? Is it ineffective or does it lead to other problems and are there any better procedures now?
3. If it does not cure the urges, I am concerned that the stretching will leave me unable to control the urges as well as I can at present, and also, whether it cures the urges or not, that it may weaken the sphincter muscles leading to loss of control and leakage either now or in later life. Has this been seen before?
I hope you are able to answer some of these questions.
since the birth of my second child, by Ceasarean section.
I have had a urodynamics test, the results of which suggested an unstable detrusor. My gynaecologist has tried drugs and bladder training to try to resolve the problem, without any success, and has now referred me to a urologist. The urologist is planning to do a cystoscopy to identify whether I have a motor or sensory problem, and at the same time has suggested a urethral stretch.
I have been looking for information about the urethral stretch (dilation), but can find very little in relation to urge incontinence, only as a cure for a stricture. The little I have found suggests that this procedure is old and has fallen out of favour with most urologists.
I have a few questions that I hope you can answer -
1. Do urologists in the US still use urethral dilation as a cure for urge incontinence?
2. If not, why has it fallen out of favour? Is it ineffective or does it lead to other problems and are there any better procedures now?
3. If it does not cure the urges, I am concerned that the stretching will leave me unable to control the urges as well as I can at present, and also, whether it cures the urges or not, that it may weaken the sphincter muscles leading to loss of control and leakage either now or in later life. Has this been seen before?
I hope you are able to answer some of these questions.
Doctor's Answer
by hfhs M.D.-AK, Sep 02, 1999 12:00AM
Dear Anne,
To directly answer your question, yes, urethral dilitation is still used by urologists in the US. The procedure is quite controversial in the urology community as to whether it really has a measurable effect (I don’t think it is harmful). If there was something better that would cure your problem, we would certainly use it, but not all cases of urgency incontinence are alike. Some patients that have had urethral dilation in the past and keep coming back because they believe it works. Often in elderly patients with atrophic vaginitis, a dilation with a cystoscope or a urethral dilators improves their symptoms. The theory behind urethral dilitation is removal of bladder outlet obstruction which is uncommon in females. Thus, returning urination to a more normal unobstructed situation, allowing for more complete emptying, easier work load for the bladder, and resolution of the urge symptoms over time.
The problem you have, urge incontinence, can be cause by several conditions. This is why we do urodynamic testing. These tests will help determine if the urgency is a motor cause, if you had documented contraction of the bladder muscle, or sensory if there was not a contraction with urodynamic testing. These tests will also look at the flow pattern of the urine and correlate it with pressures. This helps determine if there is truely an obstruction.
Although I connot recommend this procedure to you, I would not think a doctor who proposed it would be wrong. Evidently there are some therapeutic benefits recognized that have not been documented with scientific data. Make sure all of the therapeutic options and medical therapies have been considered before you consider this option. And remember, you are going to have a cystoscopy which in itself will dilate the urethral to a certain extent. Further dilation may be unnescessary.
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword:Incontinence
To directly answer your question, yes, urethral dilitation is still used by urologists in the US. The procedure is quite controversial in the urology community as to whether it really has a measurable effect (I don’t think it is harmful). If there was something better that would cure your problem, we would certainly use it, but not all cases of urgency incontinence are alike. Some patients that have had urethral dilation in the past and keep coming back because they believe it works. Often in elderly patients with atrophic vaginitis, a dilation with a cystoscope or a urethral dilators improves their symptoms. The theory behind urethral dilitation is removal of bladder outlet obstruction which is uncommon in females. Thus, returning urination to a more normal unobstructed situation, allowing for more complete emptying, easier work load for the bladder, and resolution of the urge symptoms over time.
The problem you have, urge incontinence, can be cause by several conditions. This is why we do urodynamic testing. These tests will help determine if the urgency is a motor cause, if you had documented contraction of the bladder muscle, or sensory if there was not a contraction with urodynamic testing. These tests will also look at the flow pattern of the urine and correlate it with pressures. This helps determine if there is truely an obstruction.
Although I connot recommend this procedure to you, I would not think a doctor who proposed it would be wrong. Evidently there are some therapeutic benefits recognized that have not been documented with scientific data. Make sure all of the therapeutic options and medical therapies have been considered before you consider this option. And remember, you are going to have a cystoscopy which in itself will dilate the urethral to a certain extent. Further dilation may be unnescessary.
The information provided in this forum is presented for general educational purposes only. Specific questions you have pertaining to your health should always be directed to your personal physician.
Sincerely,
HFHS M.D.-AK
*keyword:Incontinence