Incontinence: What You Should Look For In Finding A Doctor For Treatment

Audio/Video Link  *requires RealPlayer - free download

Dr. James Carter:  “Hi, this is Jim Carter, and I’m here at the AAGL meeting with OBGYN.net’s own Director of their Urogynecology section and one of my favorite doctors, Dr. Richard Scotti from the Bronx in New York.  Dr. Scotti and I participated in a debate about laparoscopic versus vaginal surgery for stress incontinence, for pelvic floor dysfunction, and pelvic floor support problems.  Dr. Scotti again showed us how we should really be doing our work and I really appreciate it.  I want to thank you for the absolutely wonderful job you did.  What I want to do right now is introduce my friend to you and have him tell you what you should look for in a doctor like him who can help you with your problems with incontinence and support.”

Dr. Richard Scotti:  “I think the first thing you want to do is find a doctor who listens a lot, understands your problems, and also understands that you have other problems besides pelvic floor support.  For example, someone may be referred to me for urinary incontinence and I find out in the course of talking and listening that this is not her major problem, and I’d like to address all of her problems.  So I think finding a doctor who listens and who understands that you have other problems besides that and then sort of helps you prioritize what you really want to work on first is, I believe, one of the first steps in finding a doctor that’s suitable for you.”

Dr. James Carter:  “I recall seeing a statistic, Dr. Scotti, it takes a patient only thirty-five seconds to tell a doctor their problem but it only takes a doctor fifteen seconds to interrupt her.  If you are looking for a physician in New York, look for one that listens and Dr. Scotti is one who listens.  I want you to tell us about what the patient should expect to be told and also what kind of an evaluation she should expect because sometimes they come in and they don’t understand that they need a machine to do a test, for instance.  Can you tell us a little about what she should expect for a work-up for incontinence?”

Dr. Richard Scotti:  “Urinary incontinence is a multi-foliate, multi-variable kind of problem and sometimes just listening to symptoms is not enough to arrive at a diagnosis so often you need other tools to triage and tease out the various symptoms.  There are only a few symptoms like frequency, urgency, painful voiding, and incontinence and these four symptoms are shared by many diagnoses.  So many diagnoses share a common pool of symptoms and, therefore, you need some instrumentation like urodynamic testing and cystoscopy, etc. to really arrive at a diagnosis and from that point, of course, formulate a rational treatment plan.”

Dr. James Carter:  “So it’s important for the patient to understand that just answering the questions may give the doctor the diagnosis but there may be some further tests like urodynamics that are needed, and you do those tests in your office.  These are not hospital tests; these are tests you do in your office.  Before a person is taken to surgery they really need a proper diagnosis.  Now Dr. Scotti, you do both vaginal approaches and laparoscopic approaches, would you tell us a little bit about some of your approaches to this treatment of this problem?”

Dr. Richard Scotti:  “Sometime people come with a particular idea; they want it laparoscopically or they want it done all from below.  The first thing is to let them understand that there are many ways to skin a cat, and we can probably do it by one approach or another or perhaps a combined approach of more than one approach.  I think informed consent involves the patient understanding what the risks and benefits of a procedure are and what the success rate might be.  There’s a scale that only they can measure, and I think the choice is up to them.  We’re not talking about emergency surgery, this is elective surgery that affects someone’s quality of life and, therefore, they have to make the decision.  Of course, we have to give them the proper information to make an informed choice.”

Dr. James Carter:  “That is so important, Dr. Scotti, the informed consent.  The patient needs to know how this is going to be done, what can be done, and you brought up yesterday in our debate this issue of intrinsic sphincter deficiency.  Now that’s a mouthful but intrinsic sphincter is a weak muscle in the urethra or weak support in the urethra and you talked about a procedure as a way of curing that with a transvaginal tape.  You called it the ‘TVT procedure’ that you’re doing.  Can you describe a little bit about that because that sounded so exciting.”

Dr. Richard Scotti:  “Sure, Dr. Carter, this is a new procedure that is minimally invasive and can actually be done under local anesthesia in about twenty minutes just for stress incontinence, this is not for other types of incontinence.  Basically, it’s a piece of synthetic tape that’s put under the urethra.  My finger represents the urethra and the rest of my hand represents the bladder, the tape - the other finger - actually supports the urethra.  It’s this way, and small punctures sites are made in the abdominal wall.  I don’t know if you can get down about here, and it takes about thirty minutes.”

Dr. James Carter:  “So for a patient with loss of urine from coughing and sneezing, you place this tape in under local anesthesia, they go home that day, and they usually can void immediately.  In fact, the success rate on this has been 85%-90%; it’s been very, very good in terms of skilled operator’s hands.  If you are interested and have problems with incontinence, contact Dr. Scotti or contact through OBGYN.net the doctors who are involved in incontinence surgery.  Check this out, this transvaginal tape procedure which was invented by a doctor in Sweden has been performed in over 100,000 cases and many, many cases, over 25,000, in the United States now has really been a benefit to people.  It has been produced by one of our major companies, Ethicon U.S.A., and we’re so excited to have this available.  Thank you for explaining all of this to us.”

Dr. Richard Scotti:  “Thank you very much, Dr. Carter.”

Dr. James Carter:  “We appreciate it.  It’s my pleasure, thank you.”