Urinary incontinence is the loss of urinary self-control due to bladder sphincter injury or neurological dysfunction, resulting in the involuntary flow of urine. Urinary incontinence can be divided into five categories according to symptoms: overflow incontinence, non-resistant incontinence, reflex incontinence, urge incontinence and stress incontinence. Etiology The causes of urinary incontinence can be divided into the following: ① congenital disorders, such as urethral cleft; ② trauma, such as women’s birth trauma, pelvic fractures, etc.; ③ surgery, such as prostate surgery and urethral stricture repair for adults; posterior urethral valve surgery for children; ④ various causes of neurogenic bladder. Clinical manifestations 1, overflow incontinence Urine constantly drips out of the urethra, and the bladder is distended in these patients. 2, non-resistant incontinence Patients with urinary incontinence all from the urethra when standing. 3.Reflex incontinence Patients involuntarily urinate intermittently (intermittent incontinence) and do not feel the urination. 4.Urgent incontinence Patients have very severe symptoms of urinary frequency and urgency, and urinary incontinence occurs due to strong uninhibited contractions of the detrusor muscle. 5.Stress incontinence is when the abdominal pressure increases (such as coughing, sneezing, going up the stairs or running), that is, urine flows out of the urethra, the cause of this type of incontinence is very complex and requires detailed examination. 1. Measurement of residual urine volume to distinguish urinary incontinence caused by high urethral resistance (lower urinary tract obstruction) from low resistance. 2.Cystourethrography If there is residual urine, perform cystourethrography during voiding to observe whether the obstruction is at the bladder neck or the external urethral sphincter. 3.Cystometry Observe whether there is no inhibitory contraction, bladder sensation and no reflex of the forceps. 4.Standing cystography Observe the presence of contrast filling in the posterior urethra. If the urethra is functioning normally, the contrast is blocked by the bladder neck; if the sympathetic nerve function related to urination is impaired, the smooth muscle of the posterior urethra is relaxed, and contrast filling can be seen in the proximal 1 to 2 cm of the posterior urethra on the film, because there is no transverse muscle in this part of the urethra. 5, Closed urethral manometry 6, Synchronous examination Synchronous examination of bladder pressure, urinary flow rate, and electromyography is performed when necessary to diagnose cough-urgent incontinence, synergistic dysfunction of the detrusor sphincter, and incontinence caused by uninhibited relaxation of the sphincter. 7. Power urethrogram A special double-lumen tube with two holes at the end, one hole is placed in the bladder and the other in the posterior urethra. In people with normal urethral function, the urethral pressure rises when the intravesical pressure increases (e.g. when coughing) to stop the outflow of urine, and in a few patients with stress incontinence, the urethral pressure does not rise when the intravesical pressure increases and thus the outflow of urine. Diagnosis Diagnosis is confirmed based on etiology, clinical manifestations and laboratory tests. Treatment 1. Large amounts of residual urine can cause stress urinary incontinence or overflow incontinence. The principle of treatment for this type of incontinence is to use surgery (bladder neck or external urethral sphincter dissection) to reduce urethral resistance to reduce residual urine. 2. Hyperreflexia of the detrusor muscle or unstable bladder can cause urge or reflex incontinence, and sometimes cough urge incontinence. The principle of treatment is to inhibit the uninhibited contraction of the bladder with drugs (such as isoptin), sacral nerve block, sacral nerve surgery or bladder nerve stripping. 3. Insufficient sphincter function In these patients with residual urine, the principle of treatment is to increase the resistance of the urethra with drugs or surgery and other methods. Patients with resistance-free incontinence can be implanted with artificial urethral sphincter devices, urethral lengthening, urethral clamps (for women) or penile clamps. 4. Perform tension-free midurethral suspension treatment. For example: TVT, TVT-O, TVT-S and other surgical treatments.