Stress Urinary Incontinence (SUI) refers to 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 during 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: stress urinary incontinence related factors: (1) age With the growth of age, the prevalence of female incontinence gradually increased, the high incidence of age 45 to 55 years. 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 old age, such as chronic lung disorders and diabetes, can also promote the progression of urinary incontinence. (2) 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, and mothers with large fetuses are at greater risk of urinary incontinence. (3) Pelvic organ prolapse Stress urinary incontinence and pelvic organ prolapse are closely related and often accompany each other. In patients with pelvic organ prolapse, thinning and disorganization of smooth muscle fibers of the pelvic floor support tissue, connective tissue fibrosis and muscle fiber atrophy may be associated with the occurrence of stress urinary incontinence. (4) Obesity The incidence of stress urinary incontinence is significantly higher in obese women, and weight loss may reduce the incidence of urinary incontinence. (5) race and genetic factors genetic factors and stress urinary incontinence have a clear correlation, the prevalence of stress urinary incontinence patients and their immediate family members prevalence significantly correlated. 3, pathophysiological mechanism: The pathophysiological mechanism of stress urinary incontinence is not completely understood, according to current research, the following factors are related: the bladder neck and proximal urethra downward shift, the urethral mucosa closure function is reduced, the intrinsic sphincter function of the urethra is reduced, the pelvic floor muscles and connective tissue function is reduced, and the nervous system dysfunction that governs the urinary control tissue structure. 4, diagnosis: according to the typical symptoms of stress urinary incontinence, that is, laughing, coughing, sneezing or walking and other degrees of abdominal pressure increase when urine overflow, stop pressure action when the urine flow can then be clearly diagnosed. 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. According to clinical symptoms, stress incontinence can be divided into three degrees: mild: no incontinence during general activities and at night, occasional incontinence when abdominal pressure increases, and 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 when standing up or changing the position of lying down, seriously affecting the patient’s life and social activities. 5, disease treatment: (1) good lifestyle
Weight loss, smoking cessation, change of diet, etc. (2) pelvic floor muscle training Through active pelvic floor training (Kegal exercise) or passive pelvic floor training (biofeedback electrical stimulation physiotherapy) will be strong pelvic floor muscle groups, so that the urethral sphincter will be strong, increase urethral closure pressure, reduce urinary incontinence. Can be implemented with reference to the following method: continuous contraction of the pelvic floor muscles (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 mild stress urinary incontinence. Incontinence symptoms may recur after stopping training. (3) Drug therapy Mainly selective α1-adrenergic receptor agonists, which stimulate α1 receptors of urethral smooth muscle, as well as stimulate somatic motor neurons and increase urethral resistance. Side effects are hypertension, palpitations, headache, cold extremities, and in severe cases, stroke. Commonly used drugs: Midodrine, methotrexate. Midodrine has less side effects than methomyl. These drugs have been shown to be effective, especially when combined with estrogen or pelvic floor muscle training. All medications are only suitable for mild incontinence. (4) Surgical treatment The main indications for surgical treatment include.
(i) Patients who have poor results or cannot adhere to non-surgical treatment, cannot tolerate it, and have poor expected results.
②Patients with moderate to severe stress urinary incontinence that seriously affects quality of life.
③Patients with high quality of life requirements.
④Patients with pelvic floor functional lesions such as pelvic organ prolapse that require pelvic floor reconstruction should undergo anti-stress incontinence surgery at the same time. 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.