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S
tress Urinary Incontinence (SUI) is the commonest cause of urinary incontinence noted worldwide.
SUI is involuntary loss of urine from the urethra when there is increase in intra- abdominal
pressure, which occurs during physical activities like coughing, sneezing, running, lifting heavy
weight or exercise. Diagnosis is made during detailed history of the symptoms, along with important past
history relating to injury to the genital tract (example during child birth); followed by meticulous
examination of the patient in supine (lying down), standing, and squatting positions. Urodynamic tests
focus on the bladder’s ability to hold urine and empty steadily and completely, that is, a study that assesses
how the bladder and urethra are performing their job of storing and releasing urine. Sonography and
cystoscopy (a tube with a camera and light to visualize the inside of the bladder) are other tests which may
be individualized as per the patients. Treatment options for Stress Urinary Incontinence are non-surgical
and surgical.
Non- surgical therapies include behavioural therapy like bladder training, fluid, and diet modification,
Kegel’s exercises and Pelvic floor muscle training and drug therapy. However, surgical therapy is well
established and over 200 different surgical procedures are described. Most effective and durable long term
therapies are Surgical. The goal of the surgical treatment is to provide sufficient urethral support to prevent
urine from leaking in cases of increased intra-abdominal pressure. When determining the optimal surgery
for a patient, factors to be considered include type of SUI, bladder capacity, severity of the problem,
associated other conditions which may require concomitant surgery (like prolapse). There are many
modifications since the advent of surgeries for SUI, to name the most common ones performed- Kelly’s
plication, retropubic suspension ( Burch colposuspension), Laparoscopic Procedures, Trans Vaginal needle
suspension procedures, sling surgery ( mid- urethral polypropylene mesh, Tension free Vaginal Tape, Trans
Obturator Tape), bulking agents, etc. Sling surgeries are the most popular and easy to perform surgeries.
The choice of the surgery depends on the cause of urinary incontinence and thus to ensure optimal efficacy
of the selected procedure with reduction in risk of complications, careful patient selection is a must.
The other common complaints are increased frequency of urination- day and/or night, inability to reach the
washroom when there an urge to pass urine (urgency) and inability to hold the urine before reaching the
toilet with some amount of leakage of urine (urge incontinence). In these patients detailed history
especially of any associated medical conditions (like diabetes, high blood pressure on treatment) is vital.
Urinary infection is also ruled out in patients with these complaints. After the diagnosis is confirmed, the
treatment is mainly pharmacological and non-surgical. The underlying medical condition should be
addressed along with the treatment for the urinary complaints; minimizing the side effect profile of these
medicines. The treatment is always individualized depending on the severity of the problems. When
patients have mixed symptoms along with SUI, non-surgical or pharmacological methods are preferred as
first line treatment followed by surgery for SUI ( if needed).Thus, to conclude, urinary symptoms are
commonly encountered problems in gynaecological practice and it is of utmost importance to focus on its
prevention along with treatment, eliminating their negative effects on the quality of life.
24 | October 2018 |