BackTable / Urology / Podcast / Episode #4
Management of Pelvic Floor Dysfunction
with Dr. Yahir Santiago-Lastra and Dr. Jose Silva
Dr. Jose Silva talks with Urologist Dr. Yahir Santiago from UC San Diego Medical Center about the diagnosis and treatment of pelvic floor dysfunction in women.
BackTable, LLC (Producer). (2021, April 21). Ep. 4 – Management of Pelvic Floor Dysfunction [Audio podcast]. Retrieved from https://www.backtable.com
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Dr. Yahir Santiago-Lastra
Dr. Yahir Santiago-Lastra is an associate professor of urology and the director of the Women's Pelvic Medicine Center at UC San Diego in California.
Dr. Jose Silva
Dr. Jose Silva is a board certified urologist practicing in Central Florida.
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.
AUA Guidelines: https://www.auanet.org/guidelines/guidelines/stress-urinary-incontinence-(sui)-guideline
EAU Guidelines: https://www.auanet.org/guidelines/guidelines/stress-urinary-incontinence-(sui)-guideline
SISTEr Trial: https://repository.niddk.nih.gov/studies/sister/
[Dr. Jose Silva]
Let's talk about sling surgery. Are you doing TBTs, TOTs, mini-sling? What are you doing? Are you doing different procedures depending on the patient and also for residents to learn? What are you doing?
[Dr. Yahir Santiago-Lastra]
I have trained to do TVTs, TOTs, mini-slings from bottom up, top down... all different kinds of slings, I've seen them all. My preferred route for sling is the retropubic sling. The reason that I like the retropubic sling, again this sling surgery is the most common surgery that I do and so, for me, the retropubic sling has the best results and it also keeps the arms of the sling within the retropubic compartment, which I think is the urologist's domain.
TOT, on the other hand, involves placement of the sling through the obturator and involves the groin and I do think that, when patients develop really severe groin pain after a TOT, it can be really debilitating to their quality of life. For me, that is prohibitive and places the TOT in a category of a type of procedure that I prefer not to perform.
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