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Stress Urinary Incontinence Updated 4/2010

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BASICS

  • Description
  • Epidemiology
  • Risk Factors
  • Pathophysiology
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Tests
  • Differential Diagnosis

TREATMENT

  • General Measures
  • Special Therapy
  • Medication (Drugs)
  • Surgery

Ongoing Care

  • Disposition
The following is an excerpt....
BASICS
Description
  • According to International Continence Society (ICS) definition, the complaint of involuntary leakage of urine during effort or exertion (coughing, sneezing), in the absence of a bladder contraction.
  • The term stress urinary incontinence also describes that the leakage from the urethra must be synchronous with the increase in the abdominal pressure.
  • When SUI is confirmed by urodynamics, it is defined as urodynamic stress incontinence (UDSUI).
Age-Related Factors

Most studies show increasing prevalence with age:

  • 5–40% in women 30–60 years of age
  • 5–45% >60 years of age
ALERT: Pregnancy Considerations
The incidence of SUI during pregnancy can be as high as 32%; by 1 year postpartum, only 3% of patients reported SUI.
ALERT: Geriatric Considerations
The ...

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See Also
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Figure 29.4. Surgical therapy for urinary incontinence. (A1–A3) Anterior vaginal wall repair, the Kelly-Kennedy procedure. (A1) Anterior vaginal wall is opened and undermined. (A2) Paraurethral tissue lateral to the urethrovesical (UV) junction is sutured. (A3) This creates a firm bar of tissue that supports the UV junction. (B1–B4) Retropubic suspension procedures, the Marshall-Marchetti-Krantz procedure. (B1) The suture is placed in the periurethral tissue and then into the pubic periosteum so that (B2) the urethra may be advanced upward into an intra-abdominal position. (B3) The Burch procedure, by which the tissue adjacent to the UV angle is sutured to the iliopectineal (Coopers) ligament. (B4) The Richardson paravaginal repair, by which the sutures are placed between the superior sulcus of the vagina and lateral pelvic side wall at the level of the iliopectineal line. (C1–C3) Sling procedures. (C1) The Pereyra procedure, by which a needle is guided transabdominally into the paraurethral tissue and back through (C2) to be tied suprapubically, thus supporting the UV angle. (C3) The Stamey procedure, by which a Dacron support material is used in the paraurethral tissue to buttress the tissue.Credit: Charles RB Beckmann, Frank W, etal. Obstetrics and Gynecology, Fifth Edition. Philadelphia: Lippincott Williams & Wilkins, 2006
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