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Abstract: This is a 60-year-old female patient who could not help but urinate when she laughed or coughed more than 20 years ago. In the last 3 months, she leaked urine even when walking fast and had to use diapers. After coming to the hospital for ultrasound and urodynamic examination, she was diagnosed with stress urinary incontinence. Since it had seriously affected her life, the patient was given standardized treatment and then did laughing, coughing and fast walking without further leakage, and the patient was discharged successfully.
[Basic information] Female, 60 years old
Type of disease】Stress urinary incontinence
Hospital】Zhengzhou First People’s Hospital
Date of consultation】April 2022
Treatment plan】Surgical treatment (vaginal tension-free midurethral suspension, urethral dilatation surgery) + intravenous infusion (levofloxacin hydrochloride for injection)
Treatment period】7 days of inpatient treatment and regular outpatient follow up
Results】The patient’s urinary leakage symptoms completely disappeared.
I. Initial consultation
The patient was 60 years old and had 3 normal deliveries. After giving birth to a child more than 20 years ago, she had urine flowing out when she laughed or coughed, which used to occur occasionally but has been occurring more and more frequently in recent years, and the urine flowed out more and more, but basically it did not affect her life greatly. In the last 3 months, not only does he urinate when he coughs and laughs, but he also leaks urine when he walks fast. Outpatient examination: no percussion pain in both kidney areas, no bulge in the suprapubic bladder area, mild prolapse of the anterior vaginal wall, normal urethral opening, the patient was asked to laugh and cough and urine was seen to flow out from the urethra.
II. Treatment history
The patient was admitted to the hospital, and the ultrasound showed that there was no significant abnormality in both kidneys, ureter and bladder, the maximum bladder capacity was about 480 ml, and the residual bladder urine was 10 ml. Urodynamic examination: urinary flow rate 27 ml/s, leakage point pressure: 28 cmH20. The diagnosis of severe stress urinary incontinence was confirmed.
In view of the current patient’s severe symptoms, severe stress urinary incontinence and poor results of conservative treatment, after communication with the patient, the patient agreed to undergo surgical treatment. Three days before the operation, vaginal irrigation and cleansing with povidone-iodine solution was performed, followed by vaginal tension-free mid-urethral suspension under combined lumbar and rigid anesthesia. After the placement of the suspension mesh was completed, the patient was allowed to do coughing and other actions on the operating table to increase abdominal pressure, and no urine leakage from the urethra was observed. After the operation, levofloxacin hydrochloride for injection was infused intravenously for 3 days, and the urinary catheter was removed after being left in place for 5 days. After 7 days of hospitalization, the patient did laughing, coughing and fast walking without leakage and was given discharge. Two days after discharge, the patient came to the hospital for review and complained of gradual dyspareunia. On examination, the patient was seen to have urethral edema, which was considered to be an inflammatory reaction, and urethral dilatation surgery was performed.
III. Treatment effect
After the urethral dilatation surgery, the patient was advised to drink more water, at least 2000ml per day. 1 week later, the patient was re-examined again and complained of smooth urination and no leakage of urine, and after the patient was asked to laugh and cough, no urine flowed out of the urethra, and the incision healed well.
IV. Notes
I am glad that after active treatment, the patient’s stress urinary incontinence has improved. The patient was advised to develop good drinking habits after discharge, drink a total of about 2000 ml of water, try to drink during the day and reduce nighttime drinking to prevent excessive nocturia. After stress urinary incontinence, the short-term complications are urinary incontinence, difficulty in urination and incisional infection, and the long-term complications are local erosion of the suspension mesh band and causing urinary fistula, etc. Once these conditions occur, timely medical attention is needed and further treatment is required if necessary.
V. Personal insight
The occurrence of stress urinary incontinence in this patient is mainly related to her history of multiple births. In addition, obesity, long-term chronic cough, smoking, long-term constipation, and diabetes mellitus are common triggers of stress urinary incontinence, so attention should be paid to weight control and non-smoking in daily life, and if constipation, diabetes mellitus, and cough are present, they should be treated promptly to avoid triggering stress urinary incontinence.
Some families want three children, and women with multiple normal births are also one of the main triggers of stress urinary incontinence. Good postpartum care and strengthening pelvic floor muscle exercises play an important role in preventing stress urinary incontinence.