A layer of muscles surround the urethra and keep it closed.  If the nerves which stimulate these muscles are injured, paralysis may occur.  As a result, the urethra may remain open (like an open faucet), and urine may leak constantly or during slight exertion.  The urethra in this situation is described as a low pressure urethra.

Surgery, trauma, and radiation may damage tissue and nerves around the urethra.  Lack of estrogen after menopause decreases blood supply to the nerves, muscles, and skin of the urethra, which in turn may create a low pressure urethra.

The goal of treatment is to increase pressure around the urethra.

• Medications - A few medications may help, but no drug alone can correct a low pressure urethra.  Vaginal estrogen cream may renew urethral blood supply, which in turn, may lead to increased pressure around the urethra.
  
  
  
• Surgery - Sling procedures which tighten around and lift up the urethra provide the highest cure rates (90%).  Beneath the vaginal lining, synthetic materials such as Gore-Tex are placed under the urethra, which is then lifted and tightened until normal urethral pressure is achieved.  After surgery, because of the increased support and pressure around the urethra, the bladder must squeeze harder to force urine out.  As a result, some women for a short time may need to wear a catheter or to perform self-catheterization.   
  CLICK HERE for more information about self-catheterization.
  
  
  
• Periurethral injections - A thick substance such as collagen injected around the urethra can also increase the pressure surrounding the urethra.  This injection can often be performed in the office with local anesthesia.  Sometimes more than one injection is needed to correct incontinence.  This procedure has a 70% two-year success rate.
  
  
  

Gynecology and Fertility Clinic
Aston Ambulatory Care Building
5303 Harry Hines Blvd., Fifth Floor, Room U5.104
Dallas, Texas 75390-8865
For a complete list of phone numbers CLICK HERE