Treatment of Stress Urinary Incontinence - An Overview
Bangladesh Journal of Obstetrics & Gynaecology
Urinary incontinence is a common condition that may affect women of all ages, with a wide range of severity and nature. Although rarely life-threatening. this bothersome symptom is experienced by a significant number of women and has a detrimental effect on quality of life. Stress urinary incontinence (SUI) is variably estimated to affect between 4% and 35% of adult women 1-3 . Data from several studies confirm that SUI is the most common type of urinary incontinence. Around 50% of women
... 50% of women reporting urine leakage are diagnosed with pure SUI 4 . A clear and logical clinical definition of SUI is essential both for delivering patient care and effectively performing outcomes research. In 2001, the International Continence Society committee on terminology put forth a well-considered set of definitions for lower urinary tract symptoms (LUTS), including SUI. 4 The International Continence Society's committee on terminology define SUI, as "the involuntary leakage of urine during increased abdominal pressure, in the absence of a detrusor contraction." The reported incidence of urinary incontinence varies widely, ranging from 8-41% in women over 65 years. Incontinence becomes more common in women with advancing age, particularly after menopause. As the percentage of postmenopausal women expected to be increasing from 23% in 1995 to 33% in 2050, it is apparant that urinary incontinent ce will be a major health hazard and quality of life issue well into the future 7 . A postal survey in 2004, conducted in four European countries (UK, France, Germany and Spain) involving over 17 000 participants found that 35% of women questioned admitted urinary incontinence. 5 In a review of all relevant studies published in English on Medline, Minassian et al. 2003 reported a median (range) prevalence of urinary incontinence of 27.6% (4.8-58.4). 6 Mechanism of urinary incontinence The normal continence of urine during stress is thought to be achieved by three mechanisms:(a) intrinsic urethral tone contributed by muscular action of the Abstract: The plethora of treatment modalities available for the treatment of female stress urinary incontinence reflects the uncertainty in the pathophysiology of this condition and the mechanism of cure. No single treatment method is suitable for all patients. For best results, many factors must be considered before choosing the treatment method most suited to the particular patient. This review examines the various treatment options available and attempts to set out criteria for choice of treatment. The role of conservative treatment has been deliberately highlighted especially for young and well motivated women with mild to moderate urinary stress incontinence before surgical treatment is used. The role and limitations of well established surgical procedures like Burch colposuspension and urethroplasty and the most recently introduced procedures like TVT/TOT,collagen implants ,laparascopic colposuspension and the role of artificial urinary sphinter are also examined.