Patients First! A urologist discusses patients’ perspectives on incontinence care

On today’s episode, we’re talking with Dr. Kathleen Kobashi, chair of the Department of Urology at Houston Methodist Hospital, about patients’ perspectives on some of the most personal conversations they’ll ever have with a healthcare provider. Doctors really do understand just how hard it is to open up about bladder and bowel problems, and Dr. Kobashi shares insights on ways to make your next appointment more comfortable and productive than you might expect.

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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 control leaks.com.

Welcome to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us today is Steve Gregg, the Executive Director for the National Association for Continence. Welcome, Steve.

Steve Gregg:Thank you, Bruce. It’s good to be here again today; I’m excited about this.

Bruce Kassover:With us today is our guest, Dr. Kathleen Kobashi, the chair of the Department of Urology at Houston Methodist Hospital in Texas. She practices with an emphasis in female pelvic medicine and reconstructive surgery; that is, she’s a specialist in women’s health and bladder control issues. So, Dr. Kobashi, welcome to the podcast. Thank you for joining us.

Dr. Kobashi:Thank you so much for having me. I’m delighted to be here.

Bruce Kassover:Excellent. So tell us. How did you get into urology? What brought you to this practice?

Dr. Kobashi:Well, I think like many people, urology is a little bit of a well kept secret. I think the word’s getting out now, but it was a little bit of luck to be honest with you.

In medical school we have an opportunity to do some elective rotations and I lucked out and, and got into urology. It so happens my dad is a urologist. That’s the reason why I did the rotation, only because he wouldn’t talk to me about it too much. But it’s a wonderful field and I’m glad to see more and more people starting to get exposed to it in med school and entering this field.

Bruce Kassover:Are there a lot of women in urology?

Dr. Kobashi:Well, that’s a great question. It is, it’s getting more and more, which I’m pleased to see. When I entered, I think there were 80 women in the United States, and now we’re, we’re getting toward 10%, just, just surpassed 10% on the last AUA survey, that I, as I understand it and I think, you know, the percentage of applicants is going up as far as women are concerned, so it’s, we’re going in the right direction.

Bruce Kassover:Excellent, but still plenty to go, I’m sure.

Dr. Kobashi:Indeed.

Bruce Kassover:So one of the things we wanted to talk with you about today are patient perspectives, really get from your point of view if, when you have a patient coming in to see you, what are some of the biggest challenges that you see the patients are presenting that can be barriers to getting proper treatment?

Dr. Kobashi:Well, I think that a lot of people don’t realize that there are treatment options for many of the things that we take care of as urologists and urogynecologists and pelvic floor specialists. The thing is that people sometimes think it’s a normal part of aging to have leaky bladder or difficulty with bladder control or things kind of falling down out of place down there, both men and women for that matter.

And so I think you’ve already got a little bit of a win if they’ve made it to your office because there’s plenty of things in our armamentarium that we can offer to really improve their quality of life. But the first barrier is just, you know, making sure they’re aware that things are available for them.

Bruce Kassover:So do you find that, that you have to do a lot of educating of your patients in the first place?

Dr. Kobashi:Yes, but thankfully, again, as I said, once they get to your office, at least they’ve gotten one step, you know, one foot in the door because they’re sitting there with you and then you have an opportunity to, you know, take it, take it away, and try to give them some relief.

Bruce Kassover:I guess when they’re there, they, they know why they’re there. So I would imagine that to some degree the ice has already been broken, but is it still hard sometimes to get them to really talk about what their issues are?

Dr. Kobashi:I mean, yes, I think it’s a very sensitive issue. Anything that has to do with, you know, with the pelvic floor and urinary tract and the gynecologic system, you know, is very sensitive to patients obviously, and again, for men as well, for, you know, genitourinary health is quite sensitive to talk about. I think that, you know, our job is, not only to educate them, but to make them comfortable and safe and present a safe environment for them to tell us some things that are pretty personal and sensitive.

I think also, it is sometimes hard to tease out what symptoms are really bothering a patient. I mean, they just know that it’s leaking. For instance, things are leaking and I don’t have very good control, but it’s important for us. It’s sort of sleuthing a little bit, right? We have to investigate and explore and try to figure out the puzzle of exactly what the cause of the leakage is for a given patient.

It’s not the same for everybody. So I think, you know, together with our patient, step off on this journey to try to figure out exactly what the root cause of their problems are so we can focus on the right thing.

Bruce Kassover:You know, that’s really interesting; I’m wondering if there’s like a vocabulary issue also. I mean, are there certain phrases or words or things that people should be saying to describe their symptoms that’ll help give you a better idea of what’s really going on?

Dr. Kobashi:Absolutely. I’m actually very impressed that you would pick up on that, but exactly. Sometimes, for instance, we’ll say to a, a patient, you know, do you leak if you cough or laugh or sneeze or run? And they say yes. And I say, okay, do you also experience urgency? Like when you have to go, you better go now.

And they say, yes. And I’ll say, which one bothers you more? And they’ll say, “The leakage.” And both of them cause leakage, right? So I mean, again, it’s then step back and really help the patient with some drawings or models or whatever it is to try to explain to them that they’re two different kinds of leakage, they’re two different problems. And if you can really understand that together. I mean, the fact is, unless we step off the line together, we’re already setting ourselves up to not be as successful as we can be. So, you’re right, it is, it’s a lot of, it’s communication, it’s vocabulary, it’s really making sure that we understand each other and that’s, you know, that’s a little bit of the, the challenge, I think.

Bruce Kassover:I’m getting the sense also from what you’re saying that you make it part of your approach to sort of take the lead if there’s any reticence on the, on the part of the patient.

Dr. Kobashi:I mean, I think that’s our job, right? It’s a little bit of being a guide and trying to help them understand what’s going on and for us to try to ferret out what’s really going on. But I think first and foremost, it’s to give them a safe and a compassionate environment where they can discuss, again, things that are very personal.

Bruce Kassover:If you’re living with a bladder or bowel issue, you know firsthand that it could be a daily struggle. It’s not like it’s something you could just ignore when there are other things you want to focus on. That’s why it’s a good idea to follow the National Association for Continence on social media. We have an active Facebook, Instagram, and Twitter page, and we put out daily tips and insider information to help you manage your condition.

If you’re looking for a little bit of inspiration or motivation, if you’re interested in finding out about new therapies or new treatment approaches, check us out. We’re putting links in the show notes to help you get there in a click, and you’ll see that it’s really worth a follow.

Steve Gregg:Dr. Kobashi, one of the issues that we see from patients all the time is less likely to occur when they come talk to you. You have time, you’re knowledgeable. You have a lot of experience in this place, but oftentimes they end up with primary cares and primary cares have limited time and oftentimes limited knowledge and don’t seem to be reticent, with the exception of men to refer on to you. How do you help manage through that process?

Dr. Kobashi:You know, that’s also an excellent question. I’m not sure, and actually I am sure that we have not tackled that as well as we could yet. We try to, when we’re out talking to our primary care team, for instance, in Houston Methodist, I’m very much in touch with them.

We try to let them know, you don’t have to do the treatment, please just open the door for the patients. Please ask them the question, do you have any bladder control concerns or issues? If. We’re more than happy to see them at that point. On the other hand, if, if they wanted to start with a medication, that’s fine, and they can come to us subsequently if things are not progressing in the right direction.

But I think, you know, again, you hit the nail right on the head. That’s the entry point, right? It’s the primary care team. Our allied health professional colleagues, our nurses, they, you know, they’ll, if they could just ask the question, open the door for the patients to say, “oh, yes, I do have that problem,” and then pass them on to us as specialists if, unless they want to try to tackle the first, you know, couple steps. And we’re happy to do that, but I know everybody’s running around busy, and so I don’t want them to not ask the question for something that we, we actually have a lot to help them with.

Steve Gregg:Yeah. It’s so important, and we haven’t, we haven’t cracked that. We have encouraged patients to not give up. You know, if you’re not getting satisfaction, make an appointment. If you can’t find a urologist, we can help you find one, unless you’re in rural America, and then it gets a little tougher.

Dr. Kobashi:Well, you know, the thing about it is now with telemedicine, we can, the rural part of things is no longer such a barrier as it was only two years ago, three years ago, that we’ve seen an accelerated implementation of telemedicine, which has many advantages. I mean, I, of course, prefer to sit in the same room with my patient. It’s nice to be there together face-to-face, but vis-a-vis this conversation we’re having right now, we can be all over the place and still touch base in a meaningful way. So I think we should probably implement that for things like bladder control issues, this is the perfect way to start to help patients.

Bruce Kassover:I’m wondering, when you see patients, do you find that as much of your role or a good portion of your role is not just being a physician, but also due to the, when you consider the nature of the problem that patients are coming to you with, do you find that a lot of your job is also to sort of be a therapist for them as well? Do you see sort of mental health issues that are related to the, the physical issues as well?

Dr. Kobashi:Sure. Actually, that’s a really great point also. I mean, you have to encourage patients, right? Not let them get discouraged. I think reassuring them that there are plenty of treatment options, successful treatment options that are not invasive, intrusive, big deal things that we can do to help them get their quality of life back.

Because you’re absolutely right. It seems like it’s one problem. Leaky bladder, for instance, or prolapse, something like that. But it’s not. It causes other problems. Right? Because they won’t, they don’t want to go out. Out to the movies or go do something socially, they start to become a lot more limited in an extreme situation, and then it becomes this sort of spiral.

So I think you’re absolutely right. It’s really coaching them and counseling them and going through their journey with them and encouraging them that there are successful treatment options available and that they’re not alone. And when we say this a lot in our circle sitting here, but I don’t know that patients really realize that they’re not alone.

And that makes it even more isolating. So a hundred percent, you’re right on, we have to play a lot of roles, I think. I never thought of it that way, but it is, and it’s a privilege to be in that, in that position.

Bruce Kassover:Excellent. So if I’m going to put you on the spot then, is there any one single piece of advice that you would say that you think stands out when it comes to helping patients come to you and deal with their issues with the proper mindset?

Dr. Kobashi:I think it’s what we’ve talked about just now. I mean, really to reassure them that they’re not alone, that this is a common but very treatable condition; whichever type of incontinence they have, whatever bladder control issues they’re having, that it’s very treatable. It’s very common. Nothing to be embarrassed about.

But we can really make a difference in quality of life. And sort of, I hear a lot, you’ve gave me my life back, which is there’s no more thrilling thing to hear from a patient, I think, than something like that.

Bruce Kassover:It’s gotta be incredibly rewarding. So thank you, Dr. Kobashi, for joining us today. We really appreciate your time and we look forward to speaking with you again in the near future.

Dr. Kobashi:Thank you so much for having me. I really appreciate it.

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 control leaks.com.

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