Stress Urinary Incontinence


Stress Incontinence happens when physical movement or activity puts pressure on the bladder (stress) causing an unintentional loss of urine. You may have stress incontinence if you leak when you:
    • cough
    • sneeze
    • run
    • lift
    • laugh
    • jump
This leakage is typically caused by weakening of the pelvic floor muscles, especially after having babies. A simple surgical procedure can keep you dry for good!



We all want control of our body. Involuntary leakage of urine with sudden movement, coughing or laughing is a life-changer at any age. Kegel exercises may help early on but rarely totally correct the problem. Any surgery involves some type entry into the human body.Thus, there is always a chance of complications. As a surgeon my job is to provide the best available care to address the patient's problem with the least chance of  complications. For ladies with urinary leakage without significant pelvic prolapse a TVT is my proven choice. I have been doing this same TVT procedure since 1998 on over 2000 patients with great success. Of these patients 345 have been operated on in the office under conscious sedation with equally good success. With any surgical procedure there is a learning curve and my success continues to improve each year. Presently there is an 85% chance of being totally free of any leakage and a 99% chance of significant improvement. As with any surgery making sure you are doing the correct procedure for the problem being addressed is of utmost importance.


The 10-year incidence of serious complications after mesh-sling surgery for stress urinary incontinence is a relatively low 3.29%, but patients treated by surgeons who perform a low volume of the procedures have a 37% higher relative risk of requiring further surgery for complications, compared with patients of experienced surgeons, according to a report published online September 9, 2015 in JAMA Surgery. Having  done over 2000 procedures with mesh without any significant complications it is hard for me to believe the mesh is the problem and this report strengthens that report. 


Most every lady has heard from a malpractice attorney if they have had any type pelvic surgery to join a class-action lawsuit for use of mesh in pelvic surgery. At some point you have to believe the doctors or the lawyers. The lawsuits concern surgery for POP(pelvic organ prolapse- in layman's terms a dropped bladder). The surgery is meant to hold the bladder up and consequently under tension causing erosion and pain and thus the lawsuits. This is not the case in the TVT which is never left under any tension. The FDA was concerned initially in 2008 about all types of mesh but in their 2011 and 2013 the warnings were only issued about the mesh used in POP procedures.To date there has never been any FDA recall for any mesh product. All major National and International GYN and Urology Societies agree the TVT  is the gold standard of care for ladies with stress urinary leakage. 


Losing control of the bladder can have some very devastating consequences, both physically and emotionally. That is why bladder control is such an important health concern for women of all ages.
Childbirth and menopause are major life events that change women's bodies forever - events that sometimes lead to urinary leakage and incontinence.  Studies report that anywhere from 17% to 55% of women are affected by bladder control problems.  But the number of women affected may actually be greater than reported. Why? Women often simply will not seek help with urinary leakage because they have been told that it is a normal part of aging.  As a result of the misconception, women try to manage on their own by making lifestyle changes, like wearing pads and dark clothing, decreasing their fluid intake and limiting their physical activity.  Younger women may quit exercising, participating in sports, or playing with their children.  Older women sometimes stop attending church, social activities and family events.  

With treatments available today, these sacrifices are unnecessary.

You will be glad to know that treatment for incontinence has come a long, long way n recent years.  Major surgery is rarely necessary anymore.  Medication is helpful for some forms of incontinence (urge incontinence).  However, if you are experiencing  stress incontinence (leaking when you cough, laugh, sneeze, lift, exercise, etc.) the best solution is a simple, outpatient procedure that offers permanent relief with no need for further medication.  This procedure is called a TVT.


TVT is done as an outpatient procedure which takes about 20 minutes, Pre-op assessment to make sure this the right procedure for you will involve detailed history and physical and possibly cystoscopy and urodynamic studies- all done in the office. Depending on insurance the TVT procedure may also be done in the office. Anesthesia with conscious sedation will be administered by an experienced nurse anesthetist. Dr. Hubbard will use long acting local along the area of the tape  to insure no significant post-op discomfort. After returning home the day of surgery the patient will  be ambulatory and allowed to go up and down steps. The day after surgery the patient is encouraged to get out of the house and walk around the block. The next day driving a car is allowed but being very careful to protect the lower abdomen. Office surgery is always done on Wednesday and many patients have gone back to work the following Monday if they have a desk job. Pain control after surgery is with Motrin 800 mg for 2-3 days. Antibiotics are presently given but since I have never had an infected tape i am considering stopping them.


1. Familiar faces and very caring staff

2. Lower co-pays and co-insurance costs

3. Less chance of infections

4. Very experienced surgeon

5. Very experienced nurse anesthetist

Presently, Anthem covers with one payment covering any and all costs involved with the surgical procedure. Certainly much less expensive than cost to have it done in a hospital. I have paper work in with Humana and should hear from them soon. I have tried in the past to work with Medicare with no luck, Since I have a lot more experience I plan to try again.

It is also very important to understand that I can only do healthy patients in the office. Having done over 3000 outpatient procedures in the office without having to transfer a single patient with anesthesia or surgical complications to the hospital I want to keep it that way. Here is what is required for an in-office TVT. 1. BMI 38 or less, 2. Non-smoker, 3. No significant cardiac or pulmonary problems, 4. No specific allergies to any anesthetic agents, or 5. Unstable asthma.

Women who have had a TVT are our happiest patients. It is also reassuring to have many doctors' wives and surgical nurses as our patients.


"My experience with having the TVT was very easy and comfortable.  From the minute I arrived at the Hubbard Clinic's in-office surgery suite, I felt comfortable and well taken care of.  Every question was answered and every step was explained.  I left the office several hours later feeling relaxed and in no pain.  Within the week, my stress incontinence was gone.  It was an easy and successful procedure.  I highly recommend the Hubbard Clinic and Dr. Hubbard to friends."

"I have been pleased with the procedure.  I have not had any complications from the surgery and it has helped with issues I had prior to the surgery. I would recommend this procedure to anyone who suffers from issues with incontinence and leakage. The Hubbard clinic did a wonderful job in all aspects of the procedure."