Urination Problems
The urologists at NewYork-Presbyterian Westchester understand how difficulty urinating can impair your quality of life. Our team is highly experienced in the care of patients with overactive bladder, underactive bladder, neurogenic bladder, incontinence, and other urination problems.
Assessing Urodynamics
We conduct a variety of tests to assess your urinary function and determine the cause of your symptoms. With the results of these tests, we can make an accurate diagnosis and tailor the most effective therapy for you. The tests include:
- Urodynamic studies to measure bladder pressure, the ability of the bladder to hold urine, bladder capacity, urine flow, and bladder emptying.
- Cystoscopy, a test in which a scope is used to examine your bladder and urethra.
- Nervous system evaluation, performed by neurologists, using imaging tests like MRI and CT scans.
Comprehensive Care for Overactive Bladder
If you find yourself feeling the urge to urinate many times a day and it also makes you get up at night, you may have overactive bladder. Our urologists offer a combination of therapies to treat overactive bladder, such as "bladder retraining" therapy and medication. We also perform Botox injections into the bladder to relax and paralyze the overactive muscle. In severe cases that don't respond well to other therapies, we have had great success using percutaneous nerve stimulation — implantation of a small pacemaker that sends impulses to the sacral nerve, which controls the bladder.
Neurogenic Bladder Treatment
With neurogenic bladder, the nerves that govern the urinary system and signal when urine should be held in or released from the bladder do not function properly, and patients lose bladder control. The bladder can become either overactive (causing increased urge to urinate or leakage) or underactive (causing retention of urine), depending on the origin of the problem. The urologists at NewYork-Presbyterian Westchester offer bladder retraining, medications, and the insertion of a catheter to drain urine for people with neurogenic bladder. If these treatments are not sufficient, our urologists are also specialty trained in surgery for neurogenic bladder, such as:
- Suprapubic tube insertion, where a tube is placed into the bladder through the abdomen.
- Urinary diversion and bladder augmentation, which divert the urine or enlarge the bladder to help protect the kidneys and maintain proper urinary function.
- Autologous fascial sling surgery, where a sling is made from a patient’s own tissues to treat stress urinary incontinence from sphincter and bladder neck problems.
- Injection of botulinum toxin into the bladder (intravesical therapy) or the urinary sphincter for patients who have small, stiff, and overactive bladders or in patients where the urinary sphincter does not relax during voiding.
- Sphincterotomy surgery for patients whose bladder and sphincter muscles do not work cooperatively. Surgeons can open the sphincter and remove a portion of the muscle.
Treating Urinary Incontinence
Our urologists evaluate and treat men and women with urinary incontinence (trouble holding your urine) that isn't due to overactive bladder or neurogenic bladder, offering bladder retraining, medications, and dietary modifications to help you gain better control over urination. You may also benefit from pelvic muscle rehabilitation, such as Kegel exercises, which we may teach you to do in combination with biofeedback (to gain awareness and control of your pelvic muscles) or pelvic floor electrical stimulation (to spur muscle contractions).
Some people require surgery for stress urinary incontinence, such as implantation of a vaginal sling in women, insertion of a male sling in men, implantation of an artificial urinary sphincter, or injection of a urethral bulking agent. For urgency incontinence, we offer sacral neuromodulation (InterStim) and injection of botulinum toxin into the bladder.