Dr. Milen Tsvetkov, MD: The autologous sling – a modern solution to stress incontinence

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Dr. Milen Tsvetkov, MD: The autologous sling – a modern solution to stress incontinence
Dr. Milen Tsvetkov, MD: The autologous sling – a modern solution to stress incontinence

Over the years he specialized in various medical facilities. He works as a resident in the urology department and a urologist specialist. He is an active member of the International continence society (ICS). At the moment, he is part of the team of the Department of Urology at MBAL - St. Sofia".

Urinary incontinence - loss of bladder control - is a much more common condition than we think. According to a National He alth and Nutrition Examination Survey conducted by the Centers for Disease Control and Prevention (CDC), approximately 51% of women and 14% of men have experienced this problem at least once in their lives.

Although urinary incontinence is in most cases completely treatable, people sometimes, considering the problem embarrassing and feeling uncomfortable to share it, do not seek treatment or are not sure who they should talk to about their symptoms. Others mistakenly believe that it is just "one of those things" they have to live with as they are part of aging. Involuntary leakage of urine is much more common in women than in men.

What are the modern methods of dealing with incontinence, we talk to Dr. Milen Tsvetkov, specialist in urology.

Dr. Tsvetkov, you applied for the first time a new method of treating involuntary leakage of urine. What is innovative in therapy?

- Operative treatment of urine leakage (in so-called stress incontinence) includes various operative techniques. In recent years, based on the accumulated surgical experience and the statistics from it, the so-called sling procedures. In this type of surgical technique, a small piece of material (sling) is surgically fixed under the urinary canal, with the aim of preventing it from opening too much during physical exertion, which would lead to leakage of urine.

For many years, artificial tissue material was used and the operative intervention was shorter, but experience has shown that the long-term effect is not good and the body reacts in one way or another against it. For this reason, we used material from the body's own tissues - a small piece of the sheath of the rectus abdominis muscle (fascia). In this operation, the sling is not a foreign body for the body and it accepts it, does not react against it.

Which patients are suitable for this method?

- Sling operative techniques are suitable for women with stress incontinence. It is a leakage of urine that occurs during physical exertion such as lifting heavy objects, coughing, sneezing.

You take material from the sheath of the rectus abdominis muscle. Is there a risk that this additional surgical intervention will lead to more serious complications?

- The intervention is very gentle and there are no serious risks. The patient's recovery is very fast, he is practically on his feet the next day.

What we have discussed so far pertains to women. And what are the most common reasons that can lead to involuntary leakage of urine in men?

- In men with complaints of leakage of urine, a thorough examination begins, because statistically the most common cause is subvesical obstruction, i.e. something interferes with the normal flow of urine, which causes the bladder to "pump" harder to expel the urine.

Most often it is the prostate gland. It can also create such a problem that it blocks the bladder, which overflows and begins to "overflow" - overflow incontinence. Incontinence can also occur after surgical interventions in the small pelvis, which often disrupt the normal innervation of pelvic organs.


What treatment is given depending on the type of incontinence?

- Patients with leakage of urine should be examined to determine the type of incontinence, as there are different types. And with each of them, the approach is different to stop the leak. Not every leak is treated with surgery.

For the type of "imperative incontinence" it is treated with medication. In "stress incontinence" the best results are achieved with surgical treatment. But there is also a drug out there that can help. That is, the approach is individual because of the type of discharge and the reasons for it.

In men, the best results for dealing with the involuntary leakage of urine is the placement of an artificial sphincter. This is a mechanism around the urethra that keeps it closed and prevents urine from escaping.

Besides being an extremely unpleasant problem, what complications can incontinence cause?

- The negative effects of leaking urine and not treating it can be physical and mental. It continues to be thought that this is a shameful problem, that if it happens to a person, he is getting old and there is nothing to be done. There are other stereotypes that do not correlate with the truth.

This problem is like any other medical case – there is an explanation, research, treatment. If left untreated, it leads to social isolation - people avoid going out, meeting people, leads to depression and sleep disorders. Depending on the type and mechanism of occurrence, untreated incontinence can increase the risk of urinary tract and genital tract infections.

There are different types

• Stress urinary incontinence

Stress urinary incontinence is a condition that causes you to leak urine when you perform an action, such as coughing, sneezing, or laughing. Stress urinary incontinence is the most common type among women, but is rare in men.

• Urge urinary incontinence

Includes problems related to the sudden urge to urinate. The amount of urine released varies from small droplets to complete emptying of the bladder. Urge urinary incontinence has a variety of causes. These can include an enlarged prostate, a urinary tract infection, or simply drinking too much fluid.

• Mixed urinary incontinence

Mixed urinary incontinence is a combination of stress urinary incontinence and urge urinary incontinence. In other words, it means that you can pass urine both due to urgency and when doing activities as mentioned above.

• Urinary incontinence due to overflow

It occurs when the bladder cannot be completely emptied. Every time the affected person urinates, a small amount remains in the bladder and therefore it gradually fills with residual urine.

• In neurological disease of the bladder

It refers to damage to the brain, spinal cord or nerves leading to incontinence, bladder problems or urination. Neurological bladder disease can affect patients who suffer from disabilities caused by trauma, stroke, multiple sclerosis, and Parkinson's disease.

• Urine dripping after urination

This is the type of involuntary release of urine shortly after a visit to the toilet. The problem is more common among men, but it can also affect women who have weak urethral muscles.

• Functional urinary incontinence

This means that you cannot reach the toilet in time, due to some physical disability related to age or living environment.

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