Female urinary incontinence is a common condition among women, with a current prevalence of nearly 50% according to global statistics, and severe incontinence of about 7%, about half of which is stress incontinence. The prevalence rate in China is basically equal to this. Such a large number of people with the disease has a serious impact on women’s quality of life and health status. Due to socio-economic and cultural factors, as well as women’s shame about urinary anomalies, female stress incontinence has not been emphasized by both doctors and patients for a long time. With the rapid growth of China’s national economy and the rapid improvement of people’s living standards, the many health and social problems caused by female stress urinary incontinence are gradually being emphasized. Therefore, it is necessary to standardize and guide the diagnosis and treatment of stress urinary incontinence in China. Advances in the guidelines for the diagnosis and treatment of stress urinary incontinence I. Overview (a) Definition Stress urinary incontinence refers to the involuntary leakage of urine from the external urethra when the abdominal pressure is increased by sneezing, coughing or exercise. Symptoms are involuntary leakage of urine on increased abdominal pressure such as coughing, sneezing, or laughing. Signs are observed as involuntary leakage of urine from the urethra on increasing abdominal pressure [1,2]. The urodynamic examination shows involuntary leakage of urine on filling cystometry in the presence of increased abdominal pressure with good urethral muscle stability [1]. (ii) Scope of this guideline Stress urinary incontinence is applicable only in women, or stress urinary incontinence with overactive bladder syndrome, pelvic organ prolapse and bladder emptying disorders. Pediatric incontinence, neurogenic incontinence, urge incontinence, filling incontinence, and all types of male incontinence are excluded from this guideline. (C) Epidemiologic characteristics Epidemiologic investigations of urinary incontinence mostly use questionnaires. The findings show a wide variation in the prevalence of the disease, which may be related to the definition of urinary incontinence used, the method of measurement, the characteristics of the study population and the method of investigation. In the female population, 23% to 45% have different degrees of urinary incontinence, and about 7% have obvious urinary incontinence symptoms [3-6], of which about 50% are stress incontinence [4]. 1, the more clear correlation factors (1) age: with age, the prevalence of female urinary incontinence gradually increases, the high incidence of age is 45-55 years old. The correlation between age and urinary incontinence may be related to the pelvic floor relaxation, estrogen reduction and urethral sphincter degenerative changes that occur with age. Some common diseases of the elderly, such as chronic pulmonary disorders and diabetes, can also contribute to the progression of urinary incontinence. However, the incidence of stress incontinence in the elderly tends to slow down, which may be related to its lifestyle changes, such as the reduction of daily activities [4-9]. (2) Childbirth: the number of births, age at first birth, mode of delivery, size of the fetus and the incidence of urinary incontinence during pregnancy are all significantly correlated with the occurrence of postpartum incontinence, and the number of births has a positive correlation with the occurrence of incontinence [10,11]; the age of first births is between 20 and 34 years old, and the correlation between the occurrence of incontinence and births is higher than that of other ages [12]; the age of births is too old, the incontinence is more likely to occur than other ages [12]; the age of births is too old, the urinary incontinence is more likely to occur than other ages [13]. age is associated with a higher likelihood of urinary incontinence [13]; women who deliver vaginally are more likely to have urinary incontinence than those who deliver by cesarean section; women who deliver by cesarean section are at greater risk of urinary incontinence than those who have not given birth [14]; the use of assisted labor techniques that accelerate labor, such as forceps, suction, and uterotonics, likewise has an increased likelihood of urinary incontinence [15]; and mothers of large-birth-weight fetuses are at greater risk of urinary incontinence is also greater [11]. (3) Pelvic organ prolapse: Pelvic organ prolapse (POP) and stress urinary incontinence seriously affect the health and quality of life of middle-aged and elderly women. Stress urinary incontinence and pelvic organ prolapse are closely related, and the two often accompany each other. In patients with pelvic organ prolapse, the pelvic floor support tissue smooth muscle fibers become thin, disorganized, connective tissue fibrosis and muscle fiber atrophy may be related to the occurrence of stress urinary incontinence [16]. (4) Obesity: obese women are significantly more likely to develop stress urinary incontinence [9,10,17,18], and weight loss may reduce the incidence of urinary incontinence [19]. (5) Race and genetic factors: genetic factors have a clearer correlation with stress urinary incontinence. The prevalence of patients with stress urinary incontinence is significantly correlated with the prevalence of their immediate family members [20,21]. The prevalence of urinary incontinence is higher in white women than in blacks [23]. 2. Possible related risk factors (1) Estrogen: Decreased estrogen has long been recognized as being associated with female stress urinary incontinence, and estrogen has been advocated for clinical treatment. However, recent data have questioned the role of estrogen and concluded that there is no correlation between changes in estrogen levels and the prevalence of stress urinary incontinence [22]. It has even been suggested that estrogen replacement therapy may aggravate incontinence symptoms [23]. (2) Hysterectomy: Stress incontinence, if it occurs after hysterectomy, usually occurs six months to one year after surgery [24]. Surgical technique and the extent of surgical resection may be related to the occurrence of urinary incontinence [25]. However, there is insufficient evidence-based medical evidence to confirm a definite correlation between hysterectomy and the development of stress urinary incontinence. (3) Smoking: the correlation between smoking and the occurrence of stress urinary incontinence is controversial. Some data suggest that the incidence of urinary incontinence is higher in smokers than in nonsmokers, which may be related to smoking-induced chronic cough and reduced collagen fiber synthesis [26,27]. There are also data that smoking is not associated with the development of urinary incontinence [18,28]. (4) Physical activity: High-intensity physical activity may induce or aggravate urinary incontinence [29], but there is a lack of sufficient evidence-based medical evidence. Other possible correlates are constipation, bowel dysfunction, caffeine intake and chronic cough [9,10,19]. Diagnosis The diagnosis of stress urinary incontinence is mainly based on subjective symptoms and objective examination, and other diseases need to be excluded. The diagnostic steps of this disease should include determining the diagnosis (highly recommended), the degree of diagnosis (recommended), the diagnosis of staging (optional) and the diagnosis of comorbid diseases (highly recommended). (a) Determine the diagnosis Purpose: to determine the presence or absence of stress urinary incontinence. The main basis: medical history and physical examination [1-6]. 1. Highly recommended (1) Medical history General condition: general condition, intelligence, cognition, and whether or not fever is present. Symptoms of stress urinary incontinence: whether urine leaks when various degrees of abdominal pressure are increased, such as laughing, coughing, sneezing, or walking; and whether the flow of urine is then terminated when the pressurizing maneuver is stopped. Other urinary symptoms: hematuria, dysuria, urinary tract irritation or lower abdominal or lumbar discomfort. Other medical history: past medical history, menstrual and reproductive history, living habits, mobility, concurrent diseases and use of drugs. (2) Physical examination General status: vital signs, gait and physical mobility, fineness and cognitive ability of things. Physical examination of the whole body: neurological examination including lower limb muscle strength, perineal sensation, anal sphincter tone and pathological signs; abdominal examination to pay attention to the presence of signs of urinary retention. Specialized examination: external genitalia with or without pelvic organ bulge and its degree [7]; vulva with or without odor and rash caused by long-term infection; bimanual diagnosis to understand the uterus level, size and pelvic floor muscle contraction force, etc.; anal diagnosis to check the sphincter muscle strength and the presence or absence of rectal bulge. Other special examinations: pressure-induced test [8], see Appendix I for details. 2. Recommendations (1) Voiding diary: 72 hours of continuous recording of urination, including the time of each urination, urine volume, drinking time, drinking volume, accompanying symptoms and incontinence time, etc., see Appendix II. (2) International Continence Advisory Committee Urinary Incontinence Questionnaire Form Short Form (ICI-QSF) [9]. The ICI-QSF form is divided into four sections to record urinary incontinence and its severity, and its impact on daily life, sex life, and mood; the ICI-Q-SF is a simplified version of the ICI-Q-LF. (3) Other tests Laboratory tests: blood and urine routine, urine culture and liver and kidney function and other general laboratory routine tests. Urine flow rate. Residual urine. 3. Optional (1) Cystoscopy: This test is required when tumors, diverticula and vesicovaginal fistulae are suspected in the bladder. (2) Invasive urodynamic examination: ① urethral pressure tracing; ② pressure-flow rate measurement; ③ abdominalleakpointpressure (abdominalleakpointpressure, ALPP) determination; ④ imaging urodynamic examination. (3) Cystourethrography. (4) Ultrasound, intravenous pyelogram, CT. (2) Degree of diagnosis Purpose: To provide reference for choosing treatment. 1. Clinical symptoms (highly recommended) Mild: no incontinence during general activities and at night, occasional incontinence when abdominal pressure increases, no need to wear a urinary pad. Moderate: frequent incontinence with increased abdominal pressure and standing up activities, need to wear a pad to live. Severe: Urinary incontinence occurs when standing up or changing the lying position, which seriously affects the patient’s life and social activities. 2.International Continence Advisory Committee Urinary Incontinence Questionnaire Short Form (ICI-Q-SF) (recommended) 3.Urinary pad test: 1 hour urinary pad test is recommended [8,10]. Mild: 1h urine leakage ≤1g. Moderate: 1g urine leakage.