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Non-surgical treatment offered for SUI by Heather Woolwine Public Relations Ten million Americans suffer from a condition so embarrassing that many wait as long as six years before they consult a physician. The condition is stress urinary incontinence (SUI), which afflicts women and some men who have undergone prostate surgery.   For relief from this frustrating and upsetting condition, MUSC’s Bladder and Pelvic Health Center and Steven Swift, M.D., urogynecologist, now offer the Tegress implant, the newest, non-surgical treatment for SUI.     SUI causes involuntary urine leakage when physical stress is exerted on the body, such as sneezing, lifting things, exercising, coughing, laughing or jumping. Many who suffer from SUI isolate themselves from social activities, and some become depressed. Forty percent of women who suffer from SUI are between ages 35 and 54, with 18 percent younger than 29. SUI results from many different factors, including surgery and giving birth. Some evidence indicates a familial predisposition for women who develop SUI.   In May 2005, FDA approved the use of the Tegress implant for the treatment of SUI. The procedure can be performed in minutes at the physician’s office and does not require a patient to take extended time off from work or family life to recover. Tegress is a bulking agent treatment for SUI, which is one of four available in the United States, including collagen, pyrohytic carbon coated zirconium oxide beads and hydroxyl coaptite.   What differentiates Tegress from other treatments is its unique delivery method and durability. Injected in liquid form through a fine needle, Tegress becomes a soft foam rubber when it comes into contact with water in peri-urethral tissues. It expands in the walls of the urethra to restore the integrity of the structure where urine passes, ultimately prohibiting involuntary leakage. Researchers and clinicians expect that patients receiving Tegress implants to have fewer additional injections after the initial procedure. Physicians must take a certification course to deliver the implant and, like other bulking agents, it is covered by most private insurance companies and Medicare.   With an effective success rate of 75 percent in clinical trials, and because of its synthetic nature, Tegress offers patients who either don’t prefer or who are not eligible for urethral surgery, another option for SUI treatment.   Surgery for SUI requires certain conditions, namely that the patient’s SUI is a result from a dropped bladder neck. In this case, the patient would benefit from a surgical procedure working much like placing the urethra in a sling to prevent involuntary leakage.   While the other bulking agents also boast a 75-percent success rate, each has its individual drawbacks. Collagen and hydroxyl coaptite (ground substance of bone) require injections more frequently, because the body breaks down those natural substances over time. Pyrohytic carbon coated zirconium oxide beads offer a more permanent solution, but the beads themselves can be difficult to place and can move over time.   MUSC and Swift are part of a study that will evaluate Tegress’ durability. Patients eligible for the trial will receive the implant for free and agree to regular contact with the implant’s manufacturer to discuss the results associated with their injections.   For information about Tegress or SUI, call 792- 4500. Strengthening the pelvic floor Many women have heard of Kegel pelvic floor exercises, especially if they have ever been pregnant. Magazines carry information about them; physicians provide brief descriptions of how to do them; and there are women who swear that if these exercises are performed at every stoplight, involuntary urine leakage will never be a problem.   “What I usually hear from patients is that they have tried Kegels and they didn’t work,” said Steven Swift, M.D., MUSC urogynecologist. “But in order to learn the correct way to perform Kegel exercises, women need to be taught by a physical therapist like Lori Nicholson at MUSC. If you don’t use a physical therapist, you can’t expect that method to bring you results.”   According to Swift, Nicholson is one of a few physical therapists in Charleston qualified to teach the appropriate method for Kegel pelvic floor exercises. Research suggests that with physician or pamphlet instruction in Kegel exercises, only 5 percent of patients were able to strengthen their pelvic floor, Swift said. If patients spent the time to work with a physical therapist on the exercises using biofeedback, the success rate was increased to 50 percent to 60 percent.     Friday, Nov. 3, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.