Debunking myths about incontinence and urology

Incontinence is such a taboo subject that, for many patients, it's more shrouded in mythology and mystery than almost any other condition. There's nothing to be afraid of! Today's guest is Dr. Kathleen Kobashi, chair of the Department of Urology at Houston Methodist Hospital and a specialist in women's health and bladder control issues, and she sheds light on the truth behind many incontinence myths and the practice of urology. 

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Transcript

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America's leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org. 

This podcast is supported by our sponsor partner Medtronic, maker of InterStim systems for bladder and bowel control. To learn more about InterStim therapy, visit controlleaks.com. 

Welcome to another episode of Life Without Leaks. I'm your host, Bruce Kassover, and joining us Dr. Kathleen Kabashi, a good friend of the podcast and chair of the department of urology at Houston Methodist hospital and a specialist in women’s health and bladder control issues, here for another conversation today in particular about misconceptions regarding incontinence. So welcome Dr. Kabashi. Thank you for joining us. 

Dr. Kathleen Kobashi: Thank you so much for having me. 

Bruce Kassover: So, Dr. Kabashi, what are some of the common misconceptions about urology? 

Dr. Kathleen Kobashi: Well, I think first and foremost, people really think about urology as a male field or that the patients are primarily male. And, and while there are a lot of males who need urologists, it's absolutely true that women can use a urologist as well.

I mean, so, bladder control issues and prolapse and that sort of thing can all be taken care of by a urologist. So easily, you know, in my practice, it's about 70/30. I mean, I see a lot of men and I enjoy seeing the men male patients also, but primarily I'm, I see women. So I think that that's one misconception that, that stops a lot of people from seeing the urologist in the first place.

Bruce Kassover: You know, I'm interested in the gender issue because, I mean, there's, there's a lot going on here. You have you, yourself, as a woman practicing as a urologist in a field, that's, that's largely male practitioners, and you have patients who, I imagine, there's often a lot of sensitivity about, you know, does a woman want to be seen by a man or a woman, or does a man mind being seen by a woman? I mean, what do you see from, from your perspective when it comes to that? 

Dr. Kathleen Kobashi: Yes. I mean, I think the world is changing every day, as you know, but, and some people do have a strong preference to see a female or a male. We absolutely try to accommodate that. Nowadays, the number of women, women urologists, female urologists in our, sort-of, workforce, I guess is just over 10%, which is a huge improvement or increase over what it was just a few years ago.

So our latest AUA census, the American Urologic Association does a census every year to take a look at what our workforce looks like and what our practices look like. And we've just, for the first time, surpassed 10 percent women out of, I think, 11,000 or 12,000 urologists in the country. So we're getting better.

I think the younger group is much more hip and progressive. And so the number of applicants that are the proportion of applicants that are women that are coming through now is getting much higher. So while the workforce is just over 10 percent, the young generation is bringing in a lot of new young energy and a lot of a lot more women in that group.

Bruce Kassover: And in addition to gender there are also, I mean, there are so many other traits that people may want to be looking for to find somebody who they feel understands them as well as possible in terms of age and race and ethnicity and things of that nature. I mean, is the field in those regards also sort of diversifying so that people have a greater number of options that really fit their own taste and temperament?

Dr. Kathleen Kobashi: Absolutely. I mean, there's been a concerted effort, a real focus on diversity and equity, not just in urology but across the medical field for sure. And urology, I've got to really commend my, the leadership, the executive leadership of the AUA and all the societies have really been working hard to do that.

The American Board of Urology, I know, has a concerted, you know, a campaign to try to really attract patients. people who typically wouldn't have even been exposed to urology. And so I think, yes, we're moving in the right direction. Maybe not as fast as we would all like, but at least we're doing it in a, in a very purposeful way, and it's really refreshing to see that. 

Bruce Kassover: So a patient walks in your door. And they present some sort of an issue. What are the things that they are most misinformed about? What are some of the myths or fears or other things that they just don't understand the reality of? 

Dr. Kathleen Kobashi: I think the main thing is that there's a lot of thoughts specific to what I do, which is, you know, bladder control issues and lower urinary tract function. I think people think it's a normal part of aging, or many people think it's a normal part of aging because, you know, you go to the supermarket and you see pads all over the place and you see commercials for pads on TV and it sort of normalizes it.

It makes it sound like that's the solution. And we've got plenty of things that we can do to treat successfully, treat different reasons for bladders not behaving properly and help them with bladder control. So I think it's a shame if people don't, if people decide they don't want treatment, that's one thing, but if they don't know that there are treatment options to consider, that's a real shame.

So we've got some work to do to get the word out there that we've got successful things that would render them, you know, that would make it so that they wouldn't need to use the pads at all in the first place. 

Bruce Kassover: That's a pretty helpful message. I mean, especially if you, if you do have patients who are coming in, who've gone for years thinking that there's nothing that could be done.

Dr. Kathleen Kobashi: A hundred percent, I agree. Well, it used to be in the dark ages when I was in training, there used to be like one medication or two medications and then a big surgery. And that was it. And now we've got all kinds of things that there's been so much attention being placed on. Patient quality of life and things that we can do to improve that; there have been improvements and advancements within this particular field rapidly.

So in the last couple of decades, so many things that we didn't even have to offer before are now, you know, sort-of are part of our normal armamentarium to deal with leaky bladders. 

Bruce Kassover: I mean, I suppose we could talk about reasons why people aren't always aware of some of these options, but I'm wondering, do you find that it's once you do present them, do you find that it's sometimes hard to sort-of convince them that, yeah, this is a legitimate thing? It really works. It's really worth giving a shot to do? Is there some resistance there? 

Dr. Kathleen Kobashi: Well, there's different, there's different presentations of patients, right? There's a patient who comes in and says, ”I'm not really sure why I'm here. My primary care doctor told me to come.” And then you have to figure out that. And then there's the patient who comes in and they're like, “I'll do anything if you can help me.” 

So, you know, I think what we have to do is sort-of figure out where the patients are in their journey and then help them understand that we have things to offer. And, you know, when you look at the AUA guidelines, American Neurologic Association and SUFU guidelines, we've accounted for the subjective piece of things, meaning how much does this bother you?

If it doesn't bother you, even if you, even if you leak six pads a day, if it doesn't bother you, we don't have to fix it. But if it bothers you, there are things that we can do. And then you go on to tell them about it. 

I think another issue is how we present it to the patients, right? I mean, we want to make sure that we present things to the patients in a way that's very friendly and not intimidating language.

So, for instance, when I tell patients about, we have a pacemaker for the bladder for patients who have overactive bladder, they've got frequency and urgency and they just can't get to the bathroom in time and it starts before they get there and they can't control it. If medications don't work, we've got several things that we can do, one of which is a pacemaker for the bladder. And the language that I use, I'm talking about this only because I want to tell you about the language that we use is, we've got a little pacemaker about the size of an Oreo cookie and we put it in under anesthesia. That's just sedation. Just like when you get your wisdom teeth pulled or you go get a colonoscopy, it's just a little sedation.

And you know, we do it in the operating room, not because it's a big operation, but because it's, we need it to be sterile since we're implanting something. So, you know, so that language, rather than saying, “Oh, we're going to put a pacemaker in your back, you know, a computer in your back” or something, you know, you can make it really not attractive or you can make it very friendly and less intimidating.

Bruce Kassover: I love that phrasing, how you call it a pacemaker because that's something people are already familiar with, you know, plenty of them have had it done themselves anyway. So that probably overcomes a big barrier that, you know, it makes it relatable. I think that that's, that's an outstanding way to put it. I love hearing that. 

Dr. Kathleen Kobashi: Thank you. You know, it's funny. I had one patient the other day when I said, “You know, it's about the size of an Oreo cookie” – or a silver dollar; I'll use silver dollar – but the Oreo cookie. One of the patients said to me, “Is it single stuff or double stuff?” 

Bruce Kassover: Well, that is better than silver dollar because nowadays I don't think anybody's seen silver dollars for years. 

Dr. Kathleen Kobashi: That's right. That's right. 

Bruce Kassover: Well, Dr. Kobashi, thank you so much for your insight. I really appreciate it. And I hope that it helps some patients get a better sense of what the reality is when it comes to dealing with their incontinence. So thank you for joining us again, we really appreciate it. 

Dr. Kathleen Kobashi: Thank you so much for giving me the opportunity to talk with you today.

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. This podcast was supported by our sponsor partner Medtronic. Makers of the InterStim Systems for Bladder and Bowel Control. To learn more about the InterStim Systems, visit controlleaks. com. 

Our music is Rainbows by Kevin MacLeod and can be found online at incompetech.com.