Stress Urinary Incontinence
Stress Urinary Incontinence (SUI) refers to the involuntary leakage of urine from the external urethral opening when abdominal pressure increases such as sneezing or coughing. Symptoms are involuntary urine leakage during increased abdominal pressure such as coughing, sneezing, or laughing. The sign is an involuntary leakage of urine from the urethra that can be observed during an increase in abdominal pressure. Urodynamic examination shows involuntary leakage of urine on filling cystometry in the presence of increased abdominal pressure without contraction of the detrusor muscle.
1.Epidemiology
23%-45% of the female population have varying degrees of urinary incontinence, and about 7% have significant symptoms of urinary incontinence, of which about 50% are stress urinary incontinence.
2.Etiology
Factors associated with stress urinary incontinence.
Age
The prevalence of urinary incontinence in women increases with age, with a high incidence at the age of 45 to 55. The correlation between age and urinary incontinence may be related to pelvic floor relaxation, estrogen reduction and degenerative changes in the urethral sphincter that occur with age. Some common diseases of the elderly, such as chronic lung disorders and diabetes, can also promote the progression of urinary incontinence.
Childbirth
There is a positive correlation between the number of births and the occurrence of urinary incontinence. Women who give birth vaginally are more likely to have urinary incontinence than women who give birth by cesarean section, and women who give birth by cesarean section are at greater risk of urinary incontinence than women who have not given birth, and the use of forceps, suction devices, oxytocin and other techniques to speed up labor and delivery also increases the likelihood of urinary incontinence, as does the risk of urinary incontinence in mothers with large fetuses.
Pelvic organ prolapse
Stress urinary incontinence and pelvic organ prolapse are closely related and often accompany each other. The thinning and disorganization of smooth muscle fibers of the pelvic floor support tissue, connective tissue fibrosis and muscle fiber atrophy in patients with pelvic organ prolapse may be associated with the development of stress incontinence.
Obesity
Obese women have a significantly higher incidence of stress urinary incontinence, and weight loss may reduce the incidence of urinary incontinence.
Ethnic and genetic factors
Genetic factors have a clear correlation with stress urinary incontinence, and the prevalence of patients with stress urinary incontinence is significantly correlated with the prevalence of their immediate family members.
3.Pathophysiological mechanism
The pathophysiological mechanism of stress urinary incontinence is not completely understood, but according to current research, it is related to the following factors: subluxation of the bladder neck and proximal urethra, reduced closure of the urethral mucosa, decreased function of the intrinsic urethral sphincter, decreased function of the pelvic floor muscles and connective tissue, and dysfunction of the nervous system that governs the structures that control urinary tissues.
4.Diagnosis
A clear diagnosis can be made based on the typical symptoms of stress urinary incontinence, i.e., whether urine overflows when various degrees of abdominal pressure increase such as laughing, coughing, sneezing or walking, and whether the urine flow is then terminated when the pressure action is stopped.
A professional diagnosis should also include the necessary physical, laboratory and instrumental examinations, pressure-induced tests, urine pad tests and incontinence questionnaires. Care should also be taken to differentiate it from common incontinence such as urge incontinence and overflow incontinence.
Based on clinical symptoms, stress incontinence can be classified into three degrees.
Mild: general activity and nocturnal incontinence, occasional incontinence when abdominal pressure increases, no need to wear a pad.
Moderate: frequent urinary incontinence with increased abdominal pressure and rising activities, requiring the wearing of a pad.
Severe: urinary incontinence occurs when rising and moving or when the position of lying changes, which seriously affects the patient’s life and social activities.
5 Disease treatment
Good lifestyle
Weight loss, smoking cessation, change of diet, etc.
Pelvic floor muscle training
There is no unified training method, the more common understanding is that the pelvic floor muscles must reach a considerable amount of training to be effective. Can refer to the following method of implementation: continuous contraction of the pelvic floor muscle (lifting movement) 2 to 6 seconds, relaxation rest 2 to 6 seconds, so repeated 10 to 15 times, 3 to 8 times a day training, for more than 8 weeks or longer. This method is convenient and easy to use and is suitable for all types of stress urinary incontinence. The duration of the therapeutic effect after stopping training is unclear.
Drug therapy
Primarily selective α1-adrenoceptor agonists that stimulate α1 receptors in urethral smooth muscle, as well as stimulation of somatic motor neurons, increase urethral resistance. Side effects are hypertension, palpitations, headache, cold extremities, and in severe cases, stroke. Commonly used drugs: Midodrine, methotrexate. Midodrine has fewer side effects than methomyl. These drugs have been shown to be effective, especially when combined with estrogen or pelvic floor muscle training.
Surgical treatment
The main indications for surgical treatment include.
(1) Patients with poor results or non-adherence to non-surgical treatment, intolerance, and poor expected outcomes.
(2) Patients with moderate to severe stress urinary incontinence that severely affects quality of life.
(3)Patients with high quality of life requirements.
(4) Patients with pelvic floor functional lesions such as pelvic organ prolapse that require pelvic floor reconstruction should undergo simultaneous anti-stress incontinence surgery.
At present, transvaginal mid-urethral sling has gradually replaced the traditional open surgery with the advantages of less injury and better efficacy, and the main modalities are TVT, TVT-O, TOT, etc. Complications mainly include urinary retention, bladder injury, and sling erosion, but the incidence is very low.