Stress incontinence refers to the involuntary flow of urine from the urethra when there is a sudden increase in abdominal pressure (such as coughing, sneezing, laughing, lifting heavy objects, etc.) when the patient is not normally incontinent. It is a common disease in adult women and rare in men. It can occur at any age, but is more common in obese middle-aged menstruating women. Wolin reported that 50.7% of 4211 healthy young women had varying degrees of stress urinary incontinence, of which 16.2% had almost constant incontinence. It is generally believed that if there is occasional overflow of urine, it cannot be pathological, and only those with frequent and marked symptoms of incontinence can be called truly stressed incontinence.
The causes of stress urinary incontinence are.
1, labor and delivery injuries: most often seen in women who have a history of obstructed labor or prolonged second stage of labor, or have performed vaginal surgery delivery. During delivery, the pelvic floor, bladder neck, urethra and other tissues are damaged.
2, vaginal and urethral surgery: such as anterior vaginal wall cystectomy, urethrovaginal fistula repair, etc., stress urinary incontinence can occur after surgery. It may be related to damage to the urethra and urethral tissues during surgery, shortening of the physiological length of the urethra after surgery, or to a decrease in urethral resistance and a decrease in closing pressure.
3, urethra and urethral tissue dysfunction: middle-aged women who develop, often due to malnutrition, physical weakness, so that the urethral bladder neck muscles and fascia atrophy, the pelvic floor can also to muscle relaxation become soft and limp, and lose support function.
4, pelvic mass: pelvic masses can cause incontinence, to disappear, incontinence can also be self-healing.
5, bladder bulge or uterine prolapse: 15-30% of these patients have urinary incontinence.
Pathogenesis.
1, the relationship between female pelvic characteristics and stress urinary incontinence.
2. Shortening of the urethra and hypotonia of the urethra.
3. Loss of the posterior angle of the urinary bladder. Many different doctrines are included, but the various doctrines are often interrelated, either causally or with the possible coexistence of several conditions.
Diagnosis.
1, Medical history questioning.
2.Gynecologic examination.
3.Elicitation test.
4.Acupressure test.
5.Urethral length measurement.
6.Cotton swab test.
7.Cystoscopy.
8.Cystourethrography.
9.Bladder and bladder sphincter manometry.
Treatment.
(i) Non-surgical treatment.
1.Strengthening pelvic floor exercises.
2.Local injection therapy.
3.Estrogen therapy.
4.Electrical stimulation therapy.
5. Drug therapy.
(II) Surgical treatment.
1.Suprapubic vesicourethral suspension.
2.Transvaginal anterior wall repair.
3, Transabdominal pubic needle bladder neck suspension.
4, fascial suspension.
The safe and reliable surgical procedure is currently recognized as the GYNECARE TVT-O (tension-free vaginal suspension).