Urinary incontinence in Medellín
First understand what type of leakage you have; then, the treatment that fits it
Involuntary loss of urine is common in women and men, and it can almost always be treated. The type of incontinence determines what works: exercises, medication, botulinum toxin or surgery. MDE Care is not a clinic: we coordinate your assessment with the urologist, the tests, the procedure and your stay in Medellín.
Step-by-step treatment
from the simplest option to surgery
What type of incontinence do you have and which treatment usually follows?
Indicate your sex, answer the international ICIQ-UI SF questionnaire about the past four weeks and a few health details. We will show you your score, the type of incontinence your answers suggest and the treatment step that usually applies.
1. Sex
Your guidance
Indicate your sex
Complete the questions to see your guidance.
* Guidance based on the ICIQ-UI SF questionnaire (Avery and colleagues, 2004) and on the guidelines of the European Association of Urology (EAU) and the American Urological Association (AUA and SUFU). It does not replace the urologist’s assessment. If leakage starts suddenly with weakness or difficulty speaking or walking, go to the emergency department.
How much urinary incontinence treatment costs in Medellín
Choose the treatment step, the tests you do not have yet and the stay if you are coming from another city. We show you the cost of each part and the estimated total.
Treatment step
Tests
Select the ones you do not have yet.
Estimated total
Assessment and tests
COP 220,000 to COP 300,000
* Estimated market values in Colombia; they are confirmed in the formal quote, which details fees, anesthesia, operating room and device. Anything without a reliable public price is quoted at the assessment. The stay refers to the partner recovery house, standard room.
What is urinary incontinence?
It is the involuntary loss of urine. It is not a normal consequence of aging or something you simply have to put up with: in most studies it affects between 25% and 45% of women, and more than 40% of women over 70. Men have it too.
In women, pregnancy, vaginal birth and menopause increase the risk. In men it usually appears after a radical prostatectomy or with prostate enlargement. What determines the treatment is the type of incontinence.
Urology or gynecology
The urologist studies how the bladder and urethra work in women and men, and treats stress incontinence, overactive bladder and male incontinence. When a woman’s leakage comes with a prolapse, that is, a descended bladder or uterus, care is coordinated with gynecology, which offers gynecological pelvic floor surgery.
The five types of urinary incontinence
Each type has a different mechanism and, therefore, a different treatment.
Stress
Leakage occurs when coughing, laughing, sneezing, lifting or exercising, due to weakness of the pelvic floor or of the sphincter that closes the urethra.
Urge
A strong, sudden need to urinate that leaves no time to reach the toilet, caused by bladder contractions. It is overactive bladder with leakage.
Mixed
It combines stress and urgency. Treatment usually starts with the predominant component.
Overflow
The bladder does not empty completely and urine spills out. In men it is usually due to an obstruction, often from an enlarged prostate.
After prostatectomy
Incontinence in men after prostate cancer surgery, due to sphincter injury. It has its own treatments.
How urinary incontinence is assessed
Diagnosis comes before any treatment, because the type of leakage determines which option works.
Step 1
Medical history and questionnaire
When and how much urine leaks, births, surgeries, medications. The ICIQ questionnaire measures severity and impact.
Step 2
Two- or three-day bladder diary
A record of what you drink, each time you urinate, the amount and any leakage. It reveals patterns that go unnoticed in the consultation.
Step 3
Physical examination and stress test
With some urine in the bladder, you are asked to cough to see the leakage; in women, the examination also checks for prolapse.
Step 4
Urinalysis and ultrasound with residual
They rule out an infection and measure how much urine remains in the bladder after urinating.
Step 5
Uroflowmetry and urodynamics
They are requested before surgery, when the type is unclear or if a previous treatment failed.
The bladder diary
- Two or three consecutive days
- Time and amount each time you urinate
- Fluids you drink and leakage, with what you were doing
Urodynamics
It measures how the bladder fills and empties. It starts with uroflowmetry, without catheters. See what it includes and its cost on the urodynamics page.
If there is blood in the urine or recurrent infections, the urologist may recommend a cystoscopy to see inside the bladder. If you are looking for a general check-up, the female urology check-up includes the assessment of leakage.
Treatment, step by step
It starts with the simplest option and moves up only if there is no improvement. The order depends on the type of incontinence.
Pelvic floor and habits
Supervised exercises for at least three months, bladder training, adjustment of fluids and caffeine, and weight control.
First step in every type
Medication
Antimuscarinics or beta-3 agonists for urgency. There is no medication indicated for stress incontinence.
Urge and mixed
Botulinum toxin
It is injected into the bladder with a cystoscope when medication does not work. Neuromodulation is the other option.
Refractory urgency
Midurethral or male sling
The midurethral sling in women and the male sling in men after prostatectomy, in mild or moderate cases.
Stress
Artificial sphincter
A cuff around the urethra that the patient opens with a pump. It is the standard in men with moderate or severe incontinence.
Stress in men
If urgency comes from an enlarged prostate, that cause is treated separately, for example with laser prostate surgery.
Midurethral sling, male sling and artificial sphincter
These are the surgeries for stress incontinence. The midurethral sling is used in women; in men, after prostatectomy, the male sling and the artificial urinary sphincter are used.
In women: midurethral sling
The midurethral sling is a mesh tape placed through a small incision in the vagina, beneath the urethra, to support it when pressure rises with coughing or straining. It is the most widely used surgery for stress incontinence, and the European guideline offers it to women seeking surgical treatment. It can be retropubic or transobturator: they differ in the path of the tape and in their risks.
Candidates
- Bothersome stress incontinence that did not improve with supervised pelvic floor training
- Leakage demonstrated on coughing during the consultation
- If mixed, with the stress component as the most bothersome
In men: sling or sphincter
In a Colombian series of male incontinence, 83% of cases followed a radical prostatectomy. Pelvic floor exercises come first; the American guideline allows surgery to be offered from 6 months if there is no improvement and recommends it at one year.
- Male sling: mild or moderate incontinence, without previous radiotherapy
- Artificial sphincter: mild to severe, after radiotherapy or if another surgery failed
- Before surgery: urodynamics and cystoscopy, depending on the case
Midurethral sling
Mesh tape beneath the urethra, through a small incision in the vagina.
Reference price
Quoted at the assessment
Usually indicated if
- Woman with stress incontinence
- No improvement with supervised pelvic floor training
Male sling
Supports the male urethra from below, with no parts to operate.
Reference price
Quoted at the assessment
Usually indicated if
- After prostatectomy, 6 to 12 months or more
- Mild or moderate incontinence
- No previous radiotherapy
Artificial urinary sphincter
A cuff around the urethra, a balloon and a pump that the patient squeezes to urinate.
Reference price
Quoted at the assessment
Usually indicated if
- Moderate or severe incontinence
- Previous radiotherapy or failure of another surgery
Botulinum toxin
Injection into the bladder wall with a cystoscope, in the office.
Reference price
Quoted at the assessment
Usually indicated if
- Overactive bladder not improved with medication
- Accepts temporary catheterization if needed
Botulinum toxin in the bladder
Botulinum toxin relaxes the bladder muscle and reduces the contractions that cause urgency. It is injected into the bladder wall with a cystoscope, almost always in the office. Guidelines offer it when overactive bladder does not improve with habits and medication, or when these are not tolerated; neuromodulation is the other alternative.
Its effect is temporary and the injection is repeated. The main risks are explained beforehand: urinary infection and the possibility of needing temporary catheterization if the bladder does not empty well.
Usually indicated if
- You have urgency with leakage that did not improve with habits, bladder training and medication
- Medication caused side effects you could not tolerate
- You accept temporary catheterization if the bladder does not empty well afterward
- You do not have an active urinary infection on the day of the injection
7.6 months
Median duration of effect
22.9%
With no leakage at all, compared with 6.5% on placebo
What studies show
Figures from clinical trials and systematic reviews. They are study averages, not a promise: the result depends on the type of incontinence and on each case.
Supervised pelvic floor training
56%
Of women with stress incontinence reported cure, compared with 6% without treatment (Cochrane review, 2018).
Midurethral sling
62% to 98%
Patient-reported cure in the first year with the transobturator sling; 71% to 97% with the retropubic one (Cochrane, 2017).
Botulinum toxin
22.9%
Of patients with refractory overactive bladder became completely dry, compared with 6.5% on placebo (EMBARK trial, 2013).
Artificial sphincter
61% to 100%
Of men achieved continence, with no pad or one pad a day, depending on the series (systematic review, 2013).
With the male sling, the European guideline reports an overall cure rate of about 60%. In the long term, patient-reported cure with the midurethral sling remains between 43% and 92%.
What recovery is like, by treatment
By phase
Midurethral sling · day of surgery
General or spinal anesthesia
The sling is placed through a small incision in the vagina.
The same day or 1 to 2 days
Discharge
Many patients go home the same day; others stay one or two nights.
1 to 3 months
Sexual activity
Within this period most women can resume sexual intercourse without problems.
Artificial sphincter · surgery
General or epidural anesthesia
The device remains deactivated while it heals.
About 6 weeks
Activation
The sphincter is activated and you are taught how to use the pump.
Botulinum toxin
It is injected in the office with a cystoscope. The effect has a median duration of 7.6 months and is repeated, usually every 3 to 12 months.
Pelvic floor
A supervised program of at least three months before assessing the result.
After prostatectomy
Exercises from the postoperative period. Surgery can be offered from 6 months if there is no improvement, and it is recommended at one year.
Risks of each treatment, with figures
Every surgery and every procedure carries risks. These are the ones reported by the largest studies; the urologist reviews them with you according to your case.
Side effects and complications
- Retropubic sling: bladder perforation4.5%
- Transobturator sling: bladder perforation0.6%
- Transobturator sling: groin pain6.4%
- Retropubic sling: groin pain1.3%
- Sling: mesh exposureAbout 2%
- Toxin: intermittent catheterization6.9%
- Sphincter: infection or erosion8.5%
- Sphincter: mechanical failure6.2%
- Male sling: chronic pain1.3% to 1.5%
26%
Artificial sphincter reoperation
Average of the series reviewed. If needed, the device is revised or replaced.
5.4%
Urinary retention with the toxin
The bladder may not empty well for a while; that is why catheterization is explained beforehand.
Type of sling
The choice changes the risk
The transobturator sling perforates the bladder less often, but causes more groin pain than the retropubic one.
Which page fits your case
Incontinence overlaps with other services. This is how they are divided, so you go straight to what you need.
Urinary incontinence
Type of leakage, step-by-step treatment, midurethral sling, botulinum toxin, male sling and artificial sphincter.
Urodynamics
If the study has already been requested and you want to know what it measures, how to prepare and how much it costs.
See urodynamicsGynecology and pelvic floor
If the leakage comes with a prolapse or a feeling of a bulge in the vagina.
See gynecological surgeryRadical prostatectomy
If you are going to have prostate surgery and want to know what to expect regarding urinary control.
See prostatectomyYour incontinence treatment in Medellín, step by step
How many days to stay is decided by the urologist according to the treatment. We coordinate the schedule so that the consultation, tests and procedure fit into as few days as possible, with the option of a recovery house for COP 759,900 (US$190) per night in a standard room.
Step 1
WhatsApp contact
You tell us your symptoms and send us any tests you already have. All information is handled confidentially.
Step 2
Bladder diary
We send you the form so you can record two or three days before traveling; you arrive at the consultation with a clear pattern.
Step 3
Prior review
The urologist reviews your tests and we tell you which ones are advisable to do in Medellín.
Step 4
Formal quote
With the detail of the consultation, the tests and the procedure, in pesos or in dollars.
Step 5
Assessment and procedure
Consultation, urodynamics if indicated and, when appropriate, the procedure, in as few days as possible.
Step 6
Check-up and follow-up
A check-up before you travel and, when the specialist considers it safe, remote follow-up.
What MDE Care does for you
We are neither a clinic nor a directory. We support you from your first question to the results consultation.
Initial guidance
We review your medical order or reason for consultation before scheduling.
The right specialist
We connect you with the urologist who performs the test you need.
Clear prices
You know the price and what it includes before booking.
Appointments and tests
We coordinate the schedule, the preparation and the timing of each step.
Logistics support
Accommodation and transport if you are coming from another city or country.
Follow-up
We coordinate the results consultation and the check-ups.
About urinary incontinence in Medellín
How much does urinary incontinence treatment cost in Medellín?
Can urinary incontinence be cured?
Are there pills for incontinence?
Do men also have incontinence?
Is it normal to leak urine after childbirth?
What is recovery like after a midurethral sling?
How long does Botox last in the bladder?
Is urodynamic testing always needed?
Which doctor treats urinary incontinence: a urologist or a gynecologist?
Other urology pages
Request your urinary incontinence assessment
Tell us your symptoms or send us your tests. We will let you know the treatment step usually considered and the price before you travel.