Ravi Bukkapatnam, Urologist in Tampa Bay, Tampa General Hospital, talks about Stress incontinence and the problem it brings to women.
So, tell us a little bit about this problem, who does it affect, and how significant is it?
BUKKAPATNAM: Stress incontinence is a very significant problem across the entire world actually and it affects women especially as they age, but it really starts even at young ages as well, typically after childbirth. What happens is that the urethra loses the support that it used to have, so women will leak typically starting with coughing and sneezing, lifting, laughing, jumping, that kind of activity. It progresses as the disease does. As the disease state progresses, it can get worse and become more bothersome. The important part is that it can affect a patient’s lifestyle, their habits, what they’re able to do. It can affect their social interactions. They tend to withdraw. It really does have a lot of deleterious health effects when one really looks at it critically.
So, treatment options before this, what would you recommend?
BUKKAPATNAM: Treatment options for stress incontinence really have evolved over the many years. People have been trying to fix stress incontinence for the last 30-plus years. And for the last three decades really, surgery was the main option in the form of sling surgery, so utilizing a piece of mesh to give the urethra support so that it has something to close against was what we did and what we still do to a large part, but as you know and I’m sure patients have seen this, mesh has its own potential side effects that one has to consider and when we look at the very young, you worry about these kind of things and want to give them the longevity of a treatment option and the safety without risks. Sling surgery was really what we did but it came with its own set of issues. Bulking agents have also made significant strides in evolution over the years, but they were all limited by the inherent issues with the agent that we were using. In the last year or so in the United States, Bulkamid has come about which is the newest agent that is well deployed. It’s very easy to give as a procedure and has minimal recovery time, is well-tolerated by patients, and critically the most important thing is a success rate that it offers patients and really cure incontinence.
What makes it different than the other agents that you use?
BUKKAPATNAM: The physical chemistry, the physical properties of the agent are completely different than what we’ve had. Many folks are nowadays familiar with cosmetic applications utilizing fillers for the face and so forth and it’s very similar to that. It’s a clear gel that is easily injected and can take shape and can really bolster the urethra. The older agents just didn’t have that property as much as what we have here.
How long does it last for?
BUKKAPATNAM: It has long term data. I’ve said that it is new in the United States, it’s the no. 1 agent in the world worldwide. In Europe this has been done for a long time. In fact, in Europe this is the preferred route for management for stress incontinence.
Does the patient have to come back at couple times or is it just one and done?
BUKKAPATNAM: It’s one and done. There can be adjustments. We can certainly sometimes have to re-treat if necessary, but for most people it’s one set of injection and they notice almost immediate relief, typically within a day or two.
Wow. That’s big for somebody who has been suffering. So yeah.
BUKKAPATNAM: Yeah. It’s very exciting. You know, the patients that we now see back are beside themselves with how easy it is to tolerate, what minimal recovery that they have, and ultimately the success rate which speaks for itself.
So, could you say it’s a cure? Is it safe to say that?
BUKKAPATNAM: Absolutely. In the stress incontinence world or in the incontinence world, cure is a relative term. We seek to improve and having done all the operations that we just talked about; I would say that this approach is a cure as closely as we can approach it.
Is it covered by most insurance?
BUKKAPATNAM: It is covered by insurances. It’s a medically approved procedure. It’s FDA approved too. You know, we always worry that we are talking about new procedures. This is not a new procedure. This is not a new material. It’s safe, effective and covered by insurance plans and by the FDA.
Is it called Bulkamid in other countries or is it … ?
BUKKAPATNAM: It is.
And it’s only about 10 minutes, right? Five, 10 minutes?
BUKKAPATNAM: It takes about five, the procedure itself. We do this either in the office or in the surgery center. It’s typically easier to tolerate in the surgery center with a little bit of anesthesia but the procedure itself takes somewhere between two and five minutes, a small camera in the urethra. There are no incisions, just about four little needle sticks to inject the material. The skill comes, of course, knowing where to inject, how to inject, how much to inject so.
Do you know how much to inject based on the patient’s weight and this that or do you just?
BUKKAPATNAM: It’s based on the appearance of what we’re able to achieve in the operating room. So very much, I would compare it to plastic surgery to sculpt any other part of the body. We’re sculpting the urethra.
When you go in, you see the urethra. What does it look like?
BUKKAPATNAM: It looks like an open tube through the camera. And once we place this, we literally watch the urethra sort of bulk up, hence Bulkamid, bulk up and close.
OK. Wow. Normally it’s not open? This is over time or just happens?
BUKKAPATNAM: Over time, over aging, you know in the older folks with menopause, change in hormonal status and the younger folks, childbirth etc.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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