The first standardized nomenclature definition of stress incontinence in the ICS (1975) clearly states that involuntary intraurethral incontinence that occurs during an increase in abdominal pressure is called stress incontinence. When abdominal pressure is increased without contraction of the forced urethral muscles, abdominal pressure is transmitted to the bladder to increase intravesical pressure, and the incontinence that occurs when bladder pressure is greater than urethral pressure and urethral closure pressure is negative is called true stress incontinence. Although stress urinary incontinence can occur in both genders and at any age, true stress urinary incontinence occurs almost exclusively in women, and true stress urinary incontinence is extremely rare in men. True stress incontinence accounts for 29.82% of patients with symptoms and signs of stress incontinence. The age range is 21-60 years, with a mean of 44.8 years. The incidence has been reported to be proportional to the number of deliveries. I. Medical history 1. history of labor and delivery, trauma 2. history of obstructed labor, pelvic and other surgeries, bowel habits II. physical examination 1. During physical examination, the first thing that the heavier patients smelled was foul-smelling urine, moist underpants, and in some cases, eczema and dermatitis in the perineum. After urination, a comprehensive examination of the genitourinary system is performed. 2, the lower abdomen and vaginal examination, pay attention to the presence of a mass. If there is a mass, check after catheterization, if there is a large amount of residual urine or chronic urinary retention, stress urinary incontinence may be a group of symptoms and signs of overflow incontinence. 3, perineum and vaginal examination, pay attention to the presence of scarring, perineal laceration scars, uterus, bladder, urethra and rectum bulge, these signs are suggestive of the bladder, urethra support tissues and pelvic floor tissues of the weakness and damage. However, the presence of the above signs does not necessarily mean the presence of true stress urinary incontinence. 4, vaginal examination, pay attention to the vaginal mucosa with or without atrophy, vagina with or without scarring and contracture, these not only give an important basis for diagnosis, but also has an important value for the choice of treatment. 5, stress incontinence test, this test is very important, must be careful. First of all, inject the bladder sterile isotonic saline 100~150ml, in the lithotomy position, ask the patient to force continuous coughing for many times, while coughing, pay attention to observe from the urethral orifice with or without streaming and squirting urine phenomenon. If there is, the stress incontinence test is positive. If it is negative, the patient should cough continuously and forcefully in sitting and standing positions, and if there is incontinence, the test is still positive. If it is negative, further examination is required. Fill the bladder with sterile isotonic saline and continue the stress incontinence test in the lithotomy position/sitting position and standing position respectively, and any incontinence found in any of the positions will be positive. 6.When the stress incontinence test is positive, the Mashall-Marchett test, also known as the bladder neck elevation test, is performed. The method is to inject 250ml of sterile isotonic saline into the bladder, take the lithotomy position, the right hand middle finger and finger inserted into the anterior wall of the vagina, were placed on both sides of the urethra, the bladder neck forward upward push the top, ask the patient to cough continuously and forcefully, to observe the urethral opening whether the flow of urine, if the test before the coughing of the flow of urine, the experimental coughing does not flow of urine, then the bladder neck elevation test is positive. In the past, a positive test was considered true stress incontinence and was used as an indication for the Marshall-Marchett-Krantz procedure. It is important to note that when performing this test, the examiner’s finger force should be directed to elevate the bladder neck, not to compress the urethra. Otherwise the results cannot be accurately determined. Therefore, a positive bladder neck elevation test alone cannot be used as a basis for diagnosing true stress incontinence or as an indication for choosing the Marshall-Marchett-Krantz procedure. It can only be used as a reference. 7, Q-tip test (Q-tiptest): this test is also known as the lever test, is used to roughly reflect the bladder urethra angle and urethral mobility of a test. With a tip of a non-injurious lever, placed in the urethra about 4cm, the tip of the bladder neck level. Ask the patient to cough repeatedly, if the bladder neck and urethra support tissue is normal, the urethra position and activity is normal, inserted into the urethra of the lever only a slight up and down swing, the lever and the angle of the horizontal line of the torso for -5o ~ +10o, if the pressure before and after the swing is very large, greater than 30o, said the bladder neck and the urethra activity is greater, then the diagnosis of true stress urinary incontinence. Third, outpatient information 1, laboratory tests: routine urinalysis, quantitative culture of mid-stream urine bacteria, all should be routinely performed. Fourth, continue to check the project 1, cystourethrography: lateral cystourethrography can well show the relationship between the bladder neck and urethra, morphology and location. With conventional methods, the urethra and bladder neck and the pelvis, femur and other bone tissues overlap, the bladder and urethra image fuzzy, can not meet the diagnostic requirements, so need a special method, in order to show a good bladder and urethra image. A catheter is inserted, and 150 ml of water-soluble contrast agent warmed to 37°C is injected into the bladder after the urine is drained to show the whole bladder. Then 15 ml of iodine oil heated to 37°C is injected into the bladder, and the iodine oil adheres to the bladder base to show the bladder base and bladder neck. The catheter is removed, and a sterilized metal pellet chain is gradually fed into the urethra from the urethral opening. The image of the pellet chain indicates the morphology and position of the urethra, and the end of the pellet chain is held with a small clip to prevent the pellet chain from slipping into the bladder. The three different substances are x-rayed at different depths, thus showing the bladder, bladder base, neck and urethra. Then, lateral cystourethrography was performed in prone and standing position and lateral cystourethrography was performed in different positions with forceful breath holding to increase abdominal pressure (Valsalva maneuver). Under different positions and different conditions such as normal breathing and breath-holding, the morphology and position of the bladder and urethra will be compared and observed. 2, urodynamic examination: (1) cystometry Many bladder diseases can cause stress urinary incontinence, and simple true stress urinary incontinence, bladder function is normal, so through the cystometry can be ruled out by bladder function abnormalities caused by symptomatic stress urinary incontinence, such as motor urge incontinence, low compliance bladder, overflow incontinence and so on. Simple true stress urinary incontinence bladder manometry indicators are normal, residual urine is zero, bladder emptying pressure below 10cmH2O, forced muscle filling pressure below 25cmH2O, no forced muscle without inhibitory contraction, compliance is normal. However, exercise urge incontinence has forced urethral muscle uninhibited contraction, and overflow incontinence can have a forced urethral muscle filling pressure as high as 52.0±29.54 cmH2O with a large amount of residual urine in addition to low bladder compliance, which is not found in other kinds of stress incontinence. In addition, in those with hypertonic detrusor dysfunction, the voiding detrusor pressure is exceptionally high, which is not found in other types of stress incontinence. (2) Static urethral manometry Static urethral manometry has a greater diagnostic value for true stress urinary incontinence, and the diagnostic value of each parameter is described below: (1) Anatomical urethral length: the relationship between true stress urinary incontinence and anatomical urethral length is inconsistent with the understanding of various schools. Our results compared with other types of stress incontinence, there is no significant difference, diagnostic significance. Functional urethral length: Due to the differences in the methods and instruments used in the measurement, the reported values of the results of the scholars on the true stress urinary incontinence, although there are some differences, but the shortening is very significant compared with the normal value. Scholars are of the opinion that functional urethral length shortening is one of the main indicators for the diagnosis of true stress urinary incontinence. ③ Maximum urethral pressure: It is currently agreed that a decrease in maximum urethral pressure is one of the main indicators for the diagnosis of true stress urinary incontinence. The maximum urethral pressure in true stress incontinence is lower than normal. In mild cases, it may overlap with the normal value, then it is not easy to distinguish. In this case, after the bladder is full, a comparison of urethral manometry is performed in the lying position and in the standing position. In normal patients, the maximal urethral pressure in the upright position is greater than that in the lying position, while the maximal urethral pressure in the upright position is lower than that in the lying position in true stress urinary incontinence. Maximum urethral closure pressure: low maximum urethral closure pressure is another important indicator for the diagnosis of true stress urinary incontinence. V. Diagnosis The most important symptom of simple true stress urinary incontinence is urinary incontinence found unintentionally for an unknown reason weeks or months after childbirth or trauma. In coughing, sneezing, laughing, physical activity and sudden increase in abdominal pressure, uncontrollable outflow of urine. In some cases, there is no sensation of urine flow, and the incontinence is only realized when the incontinence feels damp in the underwear. In some cases, it occurs immediately after difficult labor, trauma, pelvic surgery, etc., and is clearly related to trauma. Some are not directly related to the above. Those occurring during pregnancy and around menopause are mostly related to a decrease in estrogen levels. Those with constipation habits may be related to constipation. Generally, the symptoms are less severe in lying position and aggravated after getting up. Sixth, the treatment program 1, non-surgical treatment (1) to strengthen the pelvic floor muscle exercise method is to ask the patient to regularly and consciously daily anal and perineal muscle stretching and contraction exercise, in order to enhance the pelvic floor muscle and urethral muscle tone, improve the muscle reaction to the pressure effect of the contraction force. In mild cases, it can improve the symptoms, and in severe cases, it can improve the efficacy of surgery. Therefore, it is both a treatment method and can be used as a preoperative preparation. (2) Functional electrical stimulation (functional electrical stimulation) therapy Functional electrical stimulation therapy has two types of electrodes: anal pessary and vaginal pessary. It is used to enhance the function of urethral closure through electric current stimulation. The mechanism is to stimulate the efferent fibers of the pubic nerve to enhance the function of the levator ani muscle and other pelvic floor muscles as well as the periurethral transverse muscle to increase the urethral closure pressure; to stimulate the efferent fibers of the pubic nerve to the nucleus of the forced urinary tract of the sacral medulla oblongata through neuron connection to inhibit the excitability of the nucleus of the forced urinary tract, and then through the pelvic nerve to the forced urinary tract to inhibit the contraction of the forced urinary tract; and the impulses of electrical stimulation go up the thoracolumbar segment to make the sympathetic neurons excited, and the α Adrenergic receptors cause the bladder neck and the proximal part of the urethra to contract, further increasing the urethral closure function, α-adrenergic excitation, bladder base relaxation, increasing the closure of the bladder neck. (3) Drug therapy The purpose of drug therapy is twofold: to increase urethral resistance: use drugs to increase the contractile function of the urethra and increase the urethral closure pressure. Such as oral ephedrine; with drugs to enhance the tension of the pelvic floor to make the atrophied supportive tissue plump: such as the application of estrogen. Adapted to menopausal women and other causes of estrogen deficiency due to true stress urinary incontinence, it can make the epithelium of the atrophied urethra due to estrogen deficiency hyperplasia, enhance the closure function of the urethra, and at the same time, it can make the urethral mucosa under the vascular network rich, increase the urethral pressure and urethral closure pressure, and it can achieve the purpose of healing or improvement. Oral estrogen, has more side effects (Hilton, 1983). Applying estrogen paste preparation in the vagina can make the epithelial cells of urethral mucosa proliferate. 2.Surgical treatment There are more than 100 kinds of surgical methods to treat stress urinary incontinence, which can be summarized into four categories: (1) retropubic vesicourethral suspension (2) vesicourethral needle suspension (3) anterior vaginal wall repair (4) new sling surgery VII. With the continuous development of new materials and techniques (TVT, TVT-O), the surgical results of stress urinary incontinence have been very satisfactory.