Steve Fleischman, MD

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Roberta Speyer:   “Hello, today we’re talking with Dr. Fleischman about urinary  incontinence.  This is Roberta Speyer of ObGyn.net, and I have the pleasure today to be talking to a specialist  who deals with urinary incontinence in America.  Dr. Fleischman could  you tell us a little about yourself and your practice?” 

  “Sure.  I’m  currently in private practice in New Haven, Connecticut with Gynaecology  and Infertility and I’m a Clinical Instructor of Obstetrics and  Gynaecology at the Yale University School of Medicine.”
 
 

 “What about urinary  incontinence in America?  What’s the landscape?  Why has your practice  chosen to diagnose and treat urinary incontinence?  Is this something  new or is this something that’s not new but something we are hearing  more about?” 
 
 

  “I think it’s  definitely not new. It’s something we’re certainly hearing a lot more  about these days. I think when you look back on the statistics of it;  it’s fairly poorly documented in terms of how prevalent this disorder  is. We know it’s somewhere, depending on which study you’re looking at,  it’s about 10-50% of women will report urinary incontinence. Certainly  something that increases with increasing age and when you get up to  women over 64 it can be as high as 40 to 50% of the population of the  community. When you look at nursing homes it’s even greater than that,  about 50% of women who are living in nursing homes will leak urine.” 
 
 

 “Is this more prevalent in women than in men?” 
 
 

  “It certainly is more prevalent in women than in men.  It is a problem in men but not nearly as common.” 
 
 

 “What are the contributing factors to that?” 
 
 

  “Well there  are several factors. One, we certainly know that childbirth can have an  impact on it.  About 50% of women who have had vaginal deliveries will  experience some form of prolapse at some point in their future.  Unfortunately we know from most of the data that’s out there that a  small portion of those women will actually seek care. There are other  issues related to estrogen levels. There’s issues related to age and  general atrophy of the vaginal mucosa. I think the other big issue, at  least in our society today, is that the largest segment of the aging  population is the over 85 group. So when you’re dealing with a largely  increasing elderly population you’re seeing this as becoming a more  prevalent disorder.” 
 
 

 “It would be  interesting I think for the woman listening to this interview, and  certainly for the clinicians, if you could explain to us a little bit  about the typical work up for urinary incontinence?  And also include in  that, I believe as a layperson, I’ve heard that there are different  types of urinary incontinence.  Urinary incontinence isn’t one specific  problem but may be urge or stress.  So if you could fill us in a little  bit on what the different types are and how you do a work up to decide  how to treat, I think that would be very helpful to our audience.”
 
 

  “Sure.  I  think the first thing to realize about urinary incontinence is yes,  there are different types.  There’s what we refer to, and I will go into  detail a little on each of these, as genuine stress incontinence, which  typically the symptoms are leaking of urine when you laugh, cough,  sneeze, you do something with heavy lifting and it’s an involuntary loss  of urine. The second type that’s fairly common is what we call urge  incontinence or what’s also known as detrusor instability or overactive  bladder. This is more related to not as much of a structural problem  where the bladder is falling or there’s a change in the angle, but with  the muscle of the bladder.” 
 
 

 “The first type would be more of a structural problem?” 
 
 

  “Correct, and  the second, the urge incontinence is more related to what we call  overactive bladder where the muscle in the bladder is actually  contracting on its own when you don’t want it to. So an involuntary  contraction of that bladder, which gives people a sense of urgency where  they feel like they have to go to the bathroom immediately.  They can’t  wait, they get to a point and they say they need to be in a bathroom  right now, and sometimes they will leak from that.” 
 
 

  “There are  various receptors on the bladder which are either stimulated to cause  the bladder to relax or stimulated to cause the bladder to contract and  we’re not sure exactly why but in certain people they develop an over  activity of that muscle where it begins to contract on its own. There  are various reasons some can be medication. A lot of women who are put  on medications for other medical problems, such as blood pressure  medication, sometimes medications for depression can actually stimulate  the bladder or relax the bladder and cause some of these urgency  symptoms. We know that women who have severe vaginitis, if you actually  have a really bad yeast infection or bacterial infection of the vagina,  that inflammation in the vagina can actually cause some irritation of  the underside of the bladder and cause women to have urgency and  frequency symptoms at that time. So, having the symptoms, per se,  doesn’t necessarily mean it is an overactive bladder there can be other  things.  That is traditionally treated with more of a medication.” 
 
 

 “I, Dr. Fleischman,  actually had that problem and that’s why I can appreciate what you’re  saying about women going with these problems for a number of years.  I  probably had that problem for four or five years and just thought that  was because I had had children and that’s the way it was and then I  actually explained it to my physician and was treated with a pill for a  three month period of time and after that, cured.  What’s happening  during that cure, is it just you are re-educating your brain?” 
 
 

  “It’s hard to  say exactly why people don’t seek help for this.  I don’t know if it’s a  generational thing. It’s the most common complaint when I speak to most  patients. I make sure in my initial work up that in the general routine  physical exam I ask them about their urinary symptoms and the most  frequent thing they respond to me is ‘Well, yes of course, but that’s  just the way it is.’ And it’s not until you really tell them that ‘Well,  it doesn’t have to be that way and those are not necessarily normal  symptoms and we can do something about it’, that women really want to do  anything.” 
 
 

 “So is that part of  when you’re doing a work up for urinary incontinence, first of all they  have to identify that indeed they have a problem?” 
 
 

  “Right, and I  would say for me in a general ObGyn practice the way I picked up most of my incontinence work ups  actually started with a routine physical exam.   Some women come in for  their routine pap smear, who, during my review of symptoms, when I ask  them what’s going on, I always make sure I talk about general symptoms,  whether it’s vaginal pressure, whether its prolapse symptoms, but  specifically I make sure I address urinary issues. Do they leak when  they laugh, cough or sneeze, do you ever feel like you have to go to the  bathroom and when you go there’s not much there, are you getting up in  the middle of the night more than three or four times to go to the  bathroom, those sorts of symptoms. In that initial review, if any of  those things are positive, then we move on to what would be more of a  clinical work up for incontinence. 
 
 And when I talk about the clinical work up it’s very important to start  out with any time you’re talking about incontinence you want to get into  a history and figure out exactly what their history is. How long have  these symptoms been present? Is this something that just started this  year, is it something that has been going on for three years and it’s  gotten progressively worse, or is this something that happened last  week? I’ve had patients, elderly women, who suddenly developed urinary  incontinence out of nowhere.  It turns out that it’s just a bladder  infection but they didn’t get the typical symptoms they had when they  were 25 or 30 with their bladder infections, rather incontinence was  their presenting symptom. You treat the infection and they don’t leak  anymore. You want to make sure what brings on the incontinence, what  makes it better, is there anything that makes it better.  You want to  make sure you get into a good history of their drug medications that  they’re on, you want to get into childbirth history, and you want to get  into neurologic findings. There are women who had neurologic impairment  secondary to either things such as multiple sclerosis and diabetes  where they actually have some nerve damage which could entail abnormal  bladder function.” 
 
 

 “So tell us a little bit about something that’s fairly new and we don’t hear very much about, urodynamics.  Is this something that you could share with us?  How does that fit into your treatment decisions?  What are urodynamics?” 
 
 

  “I will tell  you what, let me step back a second just to get into this.  Before I’m  going to do any work deciding about urodynamics I really want to make  sure I do a thorough physical exam and that’s important any time anyone  is evaluating someone for urinary incontinence. You want to make sure  that there either is or is not pelvic prolapse associated with the  incontinence because if you are going to get into repairs at some point,  and we’ll talk about that a little later, you want to make sure that  you know what other issues are going on in the vaginal area. If they  have prolapse you often have to need to fix that at the same time you’re  going to fix their incontinence, if it’s something that can be  surgically repaired. We want to check a urinalysis and culture always to  make sure that there is no evidence of bladder infection and you  typically will check what’s called a post-void residual. You have the  patient empty their bladder and then you want to see whether or not they  do a good job emptying their bladder when they voided.  A lot of women  will have what’s called over-flow incontinence where they actually think  they empty their bladder and they still might have 200ccs in there, so  they clearly have a problem with the bladder actually emptying.” 
 
 

 “If you were using a measuring cup, what are 200ccs – maybe a tablespoon a teaspoon?” 
 
 

  “Oh, no, no, no, 200ccs would be more than a cupful.” 
 
 

 “Oh my goodness!  And they still have that much?” 
 
 

  “There are  some women that will have that type of symptom, but that typically, if  I’m going to see that, that tends to be in women that are significantly  older.  I rarely see that in my 40 to 50 year-old group but more like  those 70 years of age.” 
 
 

 “So what do you see in your 40 to 50 year-old group which is a large portion of the folks on the Internet that are using OBGYN.net.” 
 
 

 “I would say  in the 40-50 year-old group we’re talking primarily about overactive  bladder and genuine stress incontinence. Those are the two major  things.” 
 
 

 “So what can we do now with these two problems?” 
 
 

  “When a  patient comes in and has these things, the next thing we talk about is,  again, how do we know what the right diagnosis is? If someone comes in  to me the first time and really just has traditional urgency symptoms,  ‘I can’t make it to the bathroom, I feel like I always have to go’ and,  you know, ‘I’m constantly running there, I get up in the middle of the  night, multiple times a night’, that really tells me they have more  symptoms than overactive bladder.”
 
 

 “So it is the urge, the urge incontinence?”
 
 

  “With some  people you have to understand it’s not always urge incontinence, meaning  that they might not leak but it’s still something that impacts their  quality of life. If you have an overactive bladder but if you have a  very good functioning sphincter, ural sphincter, your bladder is  functioning well, you could have those symptoms and not actually leak  yet.  So if you leave it alone, at some point it might develop into a  leakage issue and most patients will say, ‘Well I have the urgency  frequency but it’s rare, but occasionally, maybe once every two, three  weeks, I might leak a little bit.” 
 
 

 “My feeling was the  closer you got to a toilet, the more the urge came on.  So my problem  was by the time I got there it was right at the end.”
 
 

  “The first  kind of symptoms really go along with more than overactive bladder.  If  someone comes in to me with strictly overactive bladder symptoms and  doesn’t really leak except when they are very close to the toilet I’m  going to start them out on a medication to treat overactive bladder  before I consider urodynamics. When you are talking about urodynamics,  what urodynamics are, just to define them, urodynamics are actually a  physiologic exam that looks at the functioning of your entire lower  urinary tract system. What that means is that typically there are  catheters, one that normally goes into the bladder and one that goes  into the vagina.  What you do is, you are trying to look at the function  of the bladder and the urethra during a sort of physiologic state. In  other words I’m going to fill the bladder with saline or with water,  sterile water, add a catheter that is measuring pressures in the bladder  and the urethra. At the same time I have a catheter in the vagina which  measures pressures in the abdomen because, again, when someone leaks  urine the reason that they leak is because there is an increase in  pressure in the abdominal cavity such as coughing, laughing, sneezing or  bearing down that overcomes the ability of the bladder to prevent it  from leaking. So you want to measure what your pressure in the bladder  is and what your pressure in the vagina is and this way you can figure  out what pressures make someone leak.  Going back to urge incontinence,  I’m going to put that off the table for now, because I generally, in  someone who just has urge incontinence, I will try to treat them  medically.” 
 
 

 “No, of course, if  you can treat something easily you’re going to do that but in a lot of  cases this problem is probably multifaceted and you have to really get  in there and figure out what the problem is.” 
 
 

  “So the goal  of your urodynamics is really to objectively reproduce the affects of  the bladder function so you can figure out what exactly you want to do.”
 
 

 “Am I correct,  you’re now able to look at what’s going on and get some types of  measurements so that you can maybe take apart the problem and  reconstruct it and understand what exactly the problem is?” 
 
 

  “Right.   Rather than taking a shotgun approach and just throwing out all these  different treatments to try to fix it, you try to objectively determine  where the exact problem lies and then come up with a treatment plan that  will deal with that individual problem rather than just trying to fix  everything and hope you get the right thing.”
 
 

 “Some of these fixes include surgery correct?” 
 
 

 “So you don’t want to be doing surgery that you don’t need to do or that isn’t the correct surgery.” 
 
 

 “Exactly. What  you are looking at is what we call multi-channel cystometry or  urodynamics. Really, there are several indications; I’ll briefly go  through some of them why you would do it.  I do it in patients who have a  really complicated history. Something that’s not just as  straightforward ‘I leak or I don’t leak.’ There are other medical  problems, there are other things going on. Whether the patient has  symptoms of stress incontinence and I’m thinking that surgery might be  in my decision treatment plan, I then go ahead.  Anyone who is going to  the operating room I want to make sure I have the right diagnosis before  I do the surgery and so I do urodynamics. If someone has urge  incontinence or they have detrusor instability, overactive bladder, any  one of those sort of same ideas, the urgency symptom, but I’ve been  treating them medically and they’re not getting any better, in those  patients I’m going to do urodynamics.  If they have had previous  surgery, let’s say someone had a procedure done five years ago, six  years ago, seven years ago for urinary incontinence, they were dry for a  few years and now they’re leaking again, before I go back in to repair  it I want to make sure I know why exactly they’re leaking again. So  those are the patients you would do it on.” 
 
 

 “A woman that comes  in and has this type of a work up is going to be able to then get a much  better personalised treatment plan.” 
 
 

  “Right, to be  honest, in my practice the thing I find the most beneficial on a  day-to-day basis with urodynamics is the ability to objectively show a  patient exactly what’s going on. Look, you have the pain when this shows  up on the monitor and the urodynamics set up I have in my office uses  some fiber optic cables, attaches to a unit which then attaches to a  laptop computer so I can have an actual printout of what’s going on  physiologically as we’re doing the study, it actually shows itself on  the computer screen.” 
 
 

 “If you had to sum  it up I think you’re trying to tell them don’t put up with this, this  isn’t normal.  But let me let you put it into your own words and we’ll  finish with that.” 
 
 

  “If I could  sum it up I would say the most important thing is, this is not normal.  Leaking urine, getting up in the middle of the night several times a  night, feeling like you constantly have to go to the bathroom, urgency,  frequency, all those things, they are not normal. These are not things  that you just say ‘I’m getting older and therefore this is a normal  occurrence.’ Urinary incontinence is a quality of life issue. And there  is no reason that a young woman in her 40s, 50s and even 60s and 70s  should have to leak urine when they don’t want to. There are treatments  out there, your doctors will know about it. So if you want to do  something about it just ask them and if your physician is not someone  who deals with this on a daily basis they can certainly refer you to an  individual who will be able to deal with it. There are physicians all  around the country who do this on daily basis. Some urologists, what we  call urogynecologist, and then a lot of general Ob/Gyns take care of this.  So, this is not something you should be living with. It’s something you  can have fixed and it’s fixed rather easily these days.” 
 
 

  “Thank you very much for this insight for women Dr. Fleischman.” 
 
 

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Urinary Incontinence - Diagnosis & Treatment

Roberta Speyer: “This is Roberta Speyer and I’m reporting for OBGYN.net. I have the pleasure of talking to Dr. Fleischman who is an Assistant Clinical Professor at Yale University and in private practice with Gynecology & Infertility, PC. Today we are going to talk about urinary incontinence and how OBGYN physicians can fit this into their practice. As a practicing OBGYN yourself, this is something you have a great degree of specialization in. Tell us a little about your practice Dr. Fleischman.”

 “I currently am a general OBGYN and serve as an Assistant Clinical Professor at the Yale University School of Medicine. I have a general obstetrics and gynecology practice called Gynecology and Infertility in New Haven Connecticut. We are a general OBGYN practice and I just happen to have a special interest in urogynecology

 I take care of all the urinary incontinence, or any urinary issues that we have in our clinic. I am one of six doctors in the practice and so I just take referrals from within the practice.” 

 “Is this a big part of physician’s practices nowadays, or could it be?” 

 “Well it certainly could be. I would say, especially in the New Haven area, where we are, it has been a very small part of the general OBGYN practice. Urologists in our town were the ones who were dealing more with urinary incontinence. What’s been most interesting, and this has been going on in multiple studies, especially from small Consumer studies – National Association for Continence - which found that basically when they asked Consumer women who they would like to take care of this problem, overwhelmingly, 75% or greater said ‘I want my OBGYN.’ Which makes sense to me.” 

 “Absolutely, most women don’t have urologists. We don’t go to them unless we have some big problem. As a woman, I would feel comfortable going to my own gynecologist. How do you find most of these women?” 

 “The corollary to it actually is that women said the biggest reason they don’t talk about urinary incontinence is they’re not asked. That is where I would say we can make a large change in our practice demographics – personally, on a routine annual exam I ask every woman, do you leak? I mean it’s part of my review of symptoms, do they have problems? And if they answer yes, it’s very difficult in an annual exam to suddenly add a whole urinary incontinence work up. But I leave the patient with the question ‘is this something you want to take care of?” We’ll look into it a little bit today but we’re going to need to set up an appointment because this is something we can take care of.’” 

 “So the first step is identifying possible candidates for getting a clinical work up for urinary incontinence just through the regular annual exam.” 

 “Then what’s the next step? First they tell you ‘Oh yes, I have this problem and that problem’ and then you progress to having a clinical work up for urinary incontinence?” 

 “Correct. It’s just like anything, with any problem we have we start off with the history. We take their history; what are their leaking symptoms like, when do they leak, when do they not leak, what are aggravating factors, what are relieving factors, are there any other medications that they’re on, any other medical problems that might impact this, physical exams, identifying any underlying causes to the incontinence, identify any pelvic support defects so when you are repairing this you make sure you do a complete repair at the time of surgery. Your typical exam is examination of the vulva and you can find multiple things, atrophy of the vulva, dermatitis, and pain symptoms can also contribute to symptoms of incontinence. People that have severe vaginitis may have urgency or frequency symptoms. People can have a urethral diverticulum, there are a lot of things you can find in a physical. But basically those are the main things you are looking for. When you move to a typical pelvic exam you are looking for things that may cause their symptoms. Whether there’s any evidence of uterine prolapse, cystocele or rectocele that may aggravate or cause these symptoms.” 

 “Do you have any other methods you use to diagnose?” 

 “I would do a urinalysis and culture, make sure there’s not an infection. Occasionally in certain patients, while it’s not a common thing, I will do a q-tip test, which is an attempt to look at urethral hypermobility. But I’m sort of moving away from that a little more. I always make sure we do a pelvic muscle assessment. Have patients squeeze their pelvic muscles as if they are trying to hold their urine, see how well their muscles are contracting to see if any sort of physical therapy may benefit beforehand. And then consider urodynamics for the sub-group of the patients who a) have a very complex medical history, b) have had previous failed surgeries c) I think I might be doing surgery on. Anyone who I’m going to do surgery on, I make sure I do a urodynamic evaluation.” 

 “Well there are two major reasons why people can leak. One would be genuine stress incontinence, which is caused by urethral hypermobility. But there is another type of incontinence called intrinsic sphincter deficiency, where it’s not so much that the neck of the bladder is hypermobile leading to pressure differentials causing incontinence, but rather a function of the urethra itself losing some of its competency. And when that happens you might change your surgical intervention based on the underlying reason for the incontinence. The other thing that if you think you are going to take someone into the operating room you really want to make sure that they really do have true stress incontinence. I’ve had some patients who say they leak when they laugh, cough or sneeze and I perform urodynamic studies and they end up not needing surgery. I had a patient three days ago, and what I ended up doing was I filled her bladder and it turned out she didn’t even know that I had filled her bladder with anything at all. Her first sensation, which you would typically expect somewhere at 150ccs, she didn’t feel until I had 500ccs in her. But I had her cough, laugh, when I had her sneeze, and when I had her do these things at volumes of 150, 200, 250, 300 she didn’t leak. But as soon as she got to about 480ccs she started leaking. She doesn’t necessarily need surgery, I told her ‘we’re going to do some bladder retraining. We’re going to get your volumes down, you shouldn’t be letting your bladder go to 500ccs.’”  

 “Should she just go to the bathroom more often?” 

 “Well, I told her go to the bathroom every three hours and see what happens. And I think in her case she won’t leak. She was putting so much pressure upon the bladder by letting it fill to 500ccs that there really was no more room for it to expand, and so the leaking at 500ccs isn’t what I would even consider abnormal. She had no concept that there was any fluid in her bladder. Overwhelmingly people with this problem don’t go to the bathroom on a regular basis.” 

 “So urodynamics can help with your surgical decisions but it can also eliminate non-surgical candidates? How do you get urodynamics into your practice economically? Is there a significant cost with this?” 

“Well, the other thing that you’ve got to keep in mind is, up to 40% of women can have what is called mixed

incontinence where they can leak urine when they laugh, cough and sneeze from genuine stress incontinence and also have some overactive bladder. So the other reason I find it useful for patient care and surgery is that if I find on the study that they have both, I can often times put them on a medication to get rid of the detrusor component and then use surgery. Because if you do surgery and then they have overactive bladder symptoms – then they think you didn’t fix anything. I can sort of graphically describe to them that there are two problems. One because of this reason and one because of the other reason, show it to them on the computer screen and explain a little bit better. Now, in terms of getting it into your practice I chose the Lumax system, which is a unit that’s very small, self-contained, and hangs on a IV stand. It has a little stand to put a laptop computer on and does all the graphic interfacing and printing reports and clinical information. It uses fiber-optic cables that are disposable so it’s very easy to use and it doesn’t take up a lot of space in my office. From a standpoint of learning how to use it – it took me three or four sessions with a company rep. She worked with me on the unit, showing me how to use it. But if you’ve done it in your residency training, and a lot of people have done some form of urodynamics at some point during their training or at least seen it, this really is a very, very basic skill set. And actually for a lot or practices it’s not even the doctors that are doing this. In most places you either have a nurse or some sort of technician that’s actually doing the study itself. In my personal practice, just because of staffing issues, I do these myself. I find that allows me to explain the surgery at the same time.” 

 “And you also get to specialize in this area because you are part of a six person clinical team?.” 

 “Right. So, it’s easier for me, especially since many of the incontinent patients are my partners’ patients. This process allows for me to meet the patients and get to know them so that I am not just meeting them on the operating table.” 

 “What’s the economics of this? Is this expensive? Can you make money on this?” 

 “It certainly is a positive economic impact on your practice. The unit itself is somewhere in the ballpark of $13,000 and each study you are looking at is somewhere around $75 for the study material. It’s about $50 for the catheters, the id tags, some tape and some tubing. And the reimbursements vary, in my area of Connecticut , Medicare is about $500 per study.

Now you have to understand that this is a study that takes about 25-35 minutes to do. So, from a standpoint of economics it pays for itself, at least for the machine, in about 30 studies.” 

 “And how many studies can someone expect to do in their practices?” 

 “In my practice we do not advertise our urodynamics so all of our patients for this service come directly from in house referrals. With that said, I book about two studies a week and I’m always booked at least four to five weeks in advance on the urodynamics. I could open up more sessions, but again I wanted general OBGYN as well, and I don’t want to make my entire practice 

. We easily made back our initial investment in the unit with just our Urodynamic patients. And that’s not including the fact that invariably the person who does the urodynamics studies also does any necessary surgeries. So not only is there a positive income from the urodynamics study but you have a positive income from you doing the surgery and taking care of the patient following the study results.” 

 “What can you say to another OBGYN who wanted to begin treating urinary incontinence in their practice? What steps should they take?” 

 “We say, ‘You know, we’re going to start taking care of this problem. We’re going to be a little more aggressive about finding out about symptoms from our patients.’ Our patients love the fact that we are not referring them somewhere. Our patients love knowing that if my partner says, ‘you’re going to see one of my partners’, not some random urologist in another office somewhere else. There’s no loss of communication, when we send them to the urologists, sometimes you get information back, sometimes you don’t. We know everything that’s going on with our patients. Our patients love it. We got the urodynamics machine in and then right from there, from the moment we got it, within three, four weeks we were already booking patients and it’s just been

 “Well, I know as a woman going to my OBGYN you get to know the whole staff too, especially if you’ve gone through pregnancy in that office. And I know that many women might not want to go to a new doctor because theirs can’t do urodynamics. They might just decide to live with it.’” 

 “I think you can give better care if you can take care of them right there in the office. I’m more inclined to let your office do something to me than I would be to go see another doctor.” 

 “I think that the other thing to keep in mind is that the treatment of urinary incontinence ten years ago was much different than it is today and a lot of the surgeries that people did traditionally have given us some complication rates. The slings were a little more invasive and a little more difficult to do and had a higher urinary retention rate. I think because we are seeing this influx of new procedures such as the TVT

 bone anchoring slings, and better medication such as Detrol LA and Ditropan XL

there will be a medication out on the market for the treatment of urinary stress incontinence.” 

 “I think that’s the new one coming out from Lilly, isn’t there?” 

 “Correct. There might have been a hesitancy to deal with some of these issues because our ability to treat them was somewhat limited. But with the technology and the ability to treat patients in an effective manner today, there is no reason why people shouldn’t really be open to this. And in 2003 with the changing economics of health care this is really an area where it’s open to a large flux of patients. Which is a positive economic impact on your practice. The patient care, customer satisfaction portion of it is just unbelievable. Patients are going to be thrilled that their OBGYN, who they’ve been seeing for X number of years is going to be taking care of this problem for them and not sending them to someone that they don’t have a relationship with. Urinary incontinence is a quality of life issue, but you know, it has its psychological self-esteem issues as well. It’s very hard to go to someone that you don’t know and never met before and talk to them about the fact that you leak urine all the time. Having someone you feel comfortable with that you have a relationship with and can also talk to about this issue is clearly what our patients want.”

 “This seems like an excellent model for treating women. You allow them to see the doctors they trust for all of their gynecological needs. And on top of that it is economically productive for the doctors involved. This is definitely a win-win for everyone involved. Thank you Dr. Fleischman.” 

Urinary Incontinence and how it fits in with an OB/GYN Practice

Hello, today we’re talking with Dr. Fleischman about urinary incontinence. This is Roberta Speyer of ObGyn.net, and I have the pleasure today to be talking to a specialist who deals with urinary incontinence in America.

Today we are going to talk about urinary incontinence and how OBGYN physicians can fit this into their practice. As a practicing OBGYN yourself, this is something you have a great degree of specialization in.

Author | Steve Fleischman, MD

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