Urinary Incontinence Specialists Germany & Switzerland

What is Urinary Incontinence?

Bladder weakness, also known as urinary incontinence in medical jargon, is a disease often concealed by patients because it is still a taboo topic in many places today. Incontinence should, however, be taken seriously. Doctors already speak of a bladder weakness even if only a few drops of urine escape involuntarily. The severity of the disease can range from a few drops of urine to a permanent secretion. In the latter case, the affected person no longer has ability to withhold even the smallest amounts of discharge.

Almost 50 percent of women over 50 years of age suffer from bladder weakness at some point in their lives. In Germany alone, at least 5 million women and men are affected.

What Types of Urinary Incontinence Exist and How do They Emerge?

Urge Incontinence

In this type of bladder weakness patients often experience a very strong and sudden urge to urinate. Most of the times, this urge is so tremendous that patients cannot even make it to the bathroom. In extreme cases, urge incontinence can even occur several times an hour.

Stress Incontinence

In urinary incontinence due to stress, the pelvic floor muscles are weakened to such an extent that an involuntary emission of urine occurs when pressure within the abdomen increases suddenly, as in coughing or sneezing. But also the lifting of heavy objects as well as weighty physical work can stimulate the unwanted urine flow. Stress incontinence may be so far advanced that urine escapes unintentionally during every movement, whether standing or lying down.

Reflex Incontinence

Reflex incontinence affected patients do not feel their bladder well. Due to neurological damage (paraplegia, Parkinson's disease, or multiple sclerosis), they cannot tell if the bladder is filled or empty. The bladder discharges urine spontaneously and the patient usually has no arbitrary influence on it.

Overflow Incontinence

As soon as the bladder fills up, it involuntarily "over-flows" in this type of incontinence. The sphincter muscles are not working properly, mostly due to neurological damage. Overflow incontinence can also be caused by an enlarged prostate (such as benign prostate hyperplasia) in which the enlarged prostate develops into an obstacle to the bladder so it cannot empty completely and thus always remains overflowed.

Extra-Urethral Incontinence

The cause of this type of incontinence lies outside the urinary tract. Often, this disease is associated with a small pathological connecting canal (called the fistula tract), which connects to the urinary tract and flows into the woman's intestine or vagina. Therefore, patients have absolutely no influence on the urinary flow, because this canal has developed unnaturally.

What Treatments Are Available for Incontinence?

Patients who suspect to suffer from incontinence should seek medical help, for example with an urologist. Specialized physicians can provide the patient with a clear diagnosis and an individual treatment plan, especially since there are no universally valid therapy recommendations for this illness. As a general rule, the sooner medical care is sought, the better the chances of recovery.

Conservative Incontinence Therapy

The following treatment options can improve urinary incontinence in most cases:

• Pelvic floor exercise
• Weight loss
• Bladder training
• Drugs

Incontinence Surgery Methods at a Glance

TVT - Tension Free-Vaginal Tape:

Involuntary urine flow in women, for example when laughing, sneezing or coughing, can be treated with a simple tension-free vaginal tape surgery. The natural endogenous band holding the urethra in place is stabilized by a one and a half centimeter thick plastic band. The urologist makes a small incision into the vagina and attaches the tape directly to the middle of the urethra and to the pubic bone or it is led around the pubis and fixed there. This is a fairly simple and uncomplicated surgical procedure that lasts only 20 to 30 minutes but has a very high success rate. The patient undergoes a spinal anesthesia (the anesthesia is usually placed near the lower spinal cord) and he is allowed to leave the clinic after four days, in some even sooner.

Gel Pad

As an alternative to band surgery, an urethral stricture can be treated with a special gel pad. The specialist injects an insoluble hydrogel depot (bulcamide gel) into the proximal area of the urethra and thus leads to a narrowing of the urethral lumen. This results in an improved closure of the urethra and the continence of affected patients enhances. This procedure is quite simple as well and can take place under local anesthesia.

Retropubic Colposuspension

In some cases of stress incontinence, raising the bladder neck through a small incision in the lower abdominal area may relieve the problem. (The bladder neck is actually the most important component for the functioning of continence.) Alternatively, keyhole surgery can be a beneficial approach here. With this method, urological surgeons set several sutures in the adjacent tissue of the urethra generating tension and therefore effectively lifting up the bladder neck. The retropubic colposuspension is a simple but quite promising intervention in the genitourinary system, which removes stress incontinence of those affected.

Incontinence Therapy in Men

In men who have incontinence due to a benign prostate tumor, the transurethral prostate resection can be applied. In this case, the surgical team removes the prostate completely or partially, so the bladder is able to work again in a natural way and continence is restored.

If restoration of continence is very difficult, doctors can insert a catheter (a small tube), which will surgically receive access to the urethra. This procedure has the task of emptying the bladder manually. Permanent or temporary catheters are implemented for this method.

Which Doctors and Medical Centers are Specialized in Urinary Incontinence?

Someone who suffers from urinary incontinence may urgently like to find out which doctor can possibly be the right contact person for his or her problem. First, the affected person should talk to his or her family doctor or a gynecologist. He can decide whether a referral to the urologist or to a continence center is necessary. A list of continence and pelvic floor centers as well as medical advice institutions in Germany and Switzerland can be found at the web page of the German continence society (‘Deutsche Kontinenz Gesellschaft’ - http://www.kontinenz-gesellschaft.de/Beratungsstellen-Zentren.6.0.html).

If you suffer from involuntary loss of urine and have not consulted a doctor yet, please do not hesitate to contact one of PRIMO MEDICO’s experts. Through early diagnosis and prompt remedial measures, stress incontinence can be treated very well and usually improved at least!

What Does Urinary Incontinence Therapy Cost?

For patients from abroad, the costs for urinary incontinence treatment are strictly regulated by the German government (GOÄ Department). German physicians are not entitled to determine their own self-calculated fees for medical services. They are legally obliged to adhere to the official fixed tariff rates for doctors.

In order to calculate the costs for a specific urinary incontinence treatment in Germany or Switzerland, medical centers first require detailed information about the specific urinary incontinence disease. This data can be transferred to the hospital in form of medical reports, findings, and images taken prior to treatment. The urinary incontinence center then prepares a cost estimate. In most cases, the amount due must be paid in advance.