An estimated 17 million Americans suffer from urinary incontinence, and women account for nearly 85% of those people. The average woman waits five years before seeking treatment for the problem. MetroHealth's Division of Urogynecology and Pelvic Reconstructive Surgery offers solutions, including:

• Pessaries. Stiff rings are inserted into the vagina, press against the wall of the vagina and resposition the urethra.
• Biofeedback
• Medication
• Surgery to repair or lift the urethra

The physician

Jeffrey Mangel, MD, Director, Division of Urogynecology and Pelvic Reconstructive Surgery. Go to www.metrohealth.org/advancedgyn or call 216-778-5890.

The patient

Sue is a 51-year-old RN who complained of progressively worsening stress incontinence for at least 10 years. Her symptoms started with leakage of urine whenever she laughed or sneezed, forcing her to cross her legs and contract her pelvic muscles, hoping to be able to hold it. When she came in for evaluation, she reported having gone to a concert downtown, jumping up to applaud and having her whole bladder let loose. She was mortified.

The evaluation

Sue went through an initial urogynecology consultation, including a detailed history and physical examination. Her work-up demonstrated that she was a good candidate for an out-patient procedure - called a midurethral sling procedure - to treat her stress incontinence.

The surgery

The sling procedure is a 30-minute surgery that involves the placement of a thin strip of synthetic material (a polypropylene mesh) underneath the middle of the urethra. This is normally done with IV sedation and local anesthesia. Sue's outpatient sling surgery was done on a Friday. She went home about two hours after her surgery, and returned to work the following Tuesday.

The result

Sue was seen about six weeks postoperatively and couldn't be happier. She continues to be followed long-term. "I have never wet my pants one time since I had that surgery about two years ago," says Sue. "I cannot tell you how grateful I am. You don't have to live like that."