Female Stress Urinary Incontinence

Abstract

Stress urinary incontinence (SUI) is a significant health problem world‐wide with considerable social and economic impact on individuals and society. The initial evaluation of urinary incontinence begins with a thorough detailed history taking, physical examination including stress test and Q-tip test, and routine laboratory studies. The pelvic examination demonstrates laxity of pelvic support, presence of any degree of prolapse. A neurologic examination should be done if neuropathy is suspected. The urodynamic study can be helpful to confirm the classic features of urinary incontinence and determine its cause. Conservative managements have been used to treat stress urinary incontinence and seem to make common sense, especially in less severe and bothersome cases. Pelvic floor muscle training appeared to be an effective treatment for adult women with stress or mixed incontinence. In pharmacologic treatment, duloxetine appears to be a promising new option for the treatment of SUI. There are literally hundreds of surgical procedures used to treat incontinence, and they are consistently being revised in going attempts to improve outcomes. Burch colposuspension and sling procedures still are the main stream but recently tension‐free vaginal tape procedure and its variants are developed and widely performed all over the world. Mid‐urethral slings showed good outcomes and are safe and brief to perform and have a relatively short learning curve. Remeex system is a relatively new surgical device introduced for the cure of SUI. Its main advantage is the possibility to adjust the sling tension if urine loss or voiding difficulties manifest after surgery. TVT‐secur procedure needs only one vaginal incision and minimal periurethral dissection for small sized mesh. Therefore, it can help make the surgery quicker and simpler. As the population of aging women increases, it is inevitable that these women’s disorders will become more prevalent. This will pose a major challenge to the health care systems. (J Korean Continence Soc 2008;12:1-9)