Management of Pelvic Floor Dysfunction

In this episode of BackTable Urology, Dr. Yahir Santiago-Lastra, director of Women's Pelvic Medicine and associate professor of medicine at UC San Diego, joins our host Dr. Jose Silva to discuss treatment and management of pelvic floor dysfunction.

Dr. Santiago-Lastra starts by distinguishing between stress incontinence and urgency incontinence. She emphasizes the importance of getting to know a patient, understanding their priorities and expectations, and correctly diagnosing the predominant type of incontinence to offer appropriate treatment. She also talks about the utility of less invasive means of evaluation, such as detailed surveys and bladder diaries, over more invasive procedures like a cystoscopy or urodynamics study.

The discussion then shifts to treatment options for stress incontinence, and Dr. Santiago-Lastra states the importance of letting the patient determine the course of treatment after learning all their options. The hosts discuss the importance of pelvic floor physical therapy, and point out the lack of access to this therapy in certain communities. They then do a deep dive into sling surgery, discussing TVTs, TOTs, and mini-slings. Dr Santiago-Lastra states her preference for retropubic slings, and warns against the severe groin pain that can be caused by TOTs. The docs also talk about contraindications for sling placement, post-op care guidelines, and considerations for younger patients.

The episode ends with Dr. Santiago-Lastra restating the importance of listening to one’s patients, and counseling them about the wide variety of treatments available. She also points out language as a barrier to accessing care, and calls for more diversity in the field so patients can feel better understood.