What Is Stress Incontinence Surgery?
23% -45% of female populations have varying degrees of urinary incontinence, and about 7% have obvious symptoms of urinary incontinence, of which about 50% are stress urinary incontinence.
- Western Medicine Name
- Stress incontinence
- English name
- Stress Urinary Incontinence, SUI
- Affiliated Department
- Surgery-urology
- The main symptoms
- Involuntary urination when abdominal pressure increases
- Main cause
- Pelvic organ prolapse, obesity, age factors, etc.
- Contagious
- Non-contagious
| Xiao Yunxiang | (Deputy Chief Physician) | Department of Urology, Peking University First Hospital |
| Wu Shiliang | (Chief physician) | Department of Urology, Peking University First Hospital |
- Stress Urinary Incontinence (SUI) refers to involuntary leakage of urine from the outer urethra when sneezing or coughing increases in abdominal pressure. Symptoms include involuntary urination when abdominal pressure increases such as cough, sneeze, and laughter. Signs are that when the abdominal pressure increases, involuntary urine flow from the urethra can be observed. Urodynamic examination showed an involuntary leak when abdomen pressure increased without detrusor contraction when filling bladder manometry was performed.
Epidemiology of stress urinary incontinence
- 23% -45% of female populations have varying degrees of urinary incontinence, and about 7% have obvious symptoms of urinary incontinence, of which about 50% are stress urinary incontinence.
Causes of stress urinary incontinence
- Related factors of stress urinary incontinence:
Age of stress urinary incontinence
- With increasing age, the prevalence of urinary incontinence in women has gradually increased, with a high incidence of 45 to 55 years. The correlation between age and urinary incontinence may be related to pelvic floor relaxation, estrogen reduction, and urethral sphincter degeneration with age. Some elderly common diseases, such as chronic lung disease and diabetes, can also promote the progress of urinary incontinence.
Stress urinary incontinence
- The number of births was positively correlated with the occurrence of urinary incontinence. Those who are too old to give birth may have a higher probability of urinary incontinence. Women who are delivered by vaginal delivery are more likely to have urinary incontinence than women who have a cesarean section. Midwifery techniques such as forceps, fetal suction devices, and oxytocin to accelerate labor also have the potential to increase urinary incontinence, and mothers of large-weight fetuses are at greater risk of urinary incontinence.
Pelvic organ prolapse due to stress urinary incontinence
- Stress urinary incontinence is closely related to pelvic organ prolapse, and the two often coexist. The thinning of the pelvic floor supporting tissue smooth muscle fibers, disordered arrangement, connective tissue fibrosis, and muscle fiber atrophy may be related to the occurrence of stress urinary incontinence in patients with pelvic organ prolapse.
Stress incontinence obesity
- Obese women have a significantly higher chance of stress urinary incontinence, and weight loss can reduce the incidence of urinary incontinence.
Race and genetic factors of stress incontinence
- There is a clear correlation between genetic factors and stress urinary incontinence. The prevalence of patients with stress urinary incontinence is significantly related to the prevalence of their immediate family members.
Pathophysiology of stress urinary incontinence
- The pathophysiology of stress urinary incontinence has not been fully understood. According to the current research, it is related to the following factors: bladder neck and proximal urethral downward movement, urethral mucosal occlusion decline, intrinsic sphincter function decline, Connective tissue function declines, and nervous system dysfunction governs urinary tissue structure.
Diagnosis of stress urinary incontinence
- According to the typical symptoms of stress urinary incontinence, that is, laughter, cough, sneeze, or walking, the urine overflows when the abdominal pressure increases in various degrees, and whether the urine flow is terminated immediately when the pressurization action is stopped can be clearly diagnosed.
- Professional diagnosis should also include necessary physical examinations, laboratory examinations and equipment examinations, pressure-induced tests, urine pad tests and urinary incontinence questionnaires. Attention should also be paid to distinguishing from common urinary incontinence such as urge incontinence and overflow urinary incontinence.
- According to clinical symptoms, stress urinary incontinence can be divided into three degrees:
- Mild: general activities and no urinary incontinence at night, occasional urinary incontinence when abdominal pressure increases, no need to wear a urine pad.
- Moderate: Increased abdominal pressure and standing activities, frequent urinary incontinence, need to wear a urine pad to live.
- Severe: Urinary incontinence occurs when the standing position or the posture changes, which seriously affects the patient's life and social activities.
Treatment of stress urinary incontinence
Stress urinary incontinence good lifestyle
- Lose weight, quit smoking, change eating habits, etc.
Pelvic floor muscle training for stress urinary incontinence
- At present, there is no unified training method. It is more commonly recognized that the pelvic floor muscles must reach a considerable amount of training to be effective. It can be implemented by referring to the following methods: continuous contraction of the pelvic floor muscles (anus levator movement) for 2 to 6 seconds, relaxation and rest for 2 to 6 seconds, repeating 10 to 15 times in this way, training 3 to 8 times a day for 8 weeks or more. This method is convenient and easy to apply, and is suitable for various types of stress urinary incontinence. The duration of efficacy after discontinuing training is unknown.
Stress incontinence medication
- It is mainly a selective 1-adrenergic receptor agonist, which can stimulate 1 receptor of urethral smooth muscle, and stimulate somatic motor neurons, increasing urethral resistance. Side effects include high blood pressure, palpitations, headaches, and cold extremities. Strokes can occur in severe cases. Commonly used drugs: Midodrine, methoxamine. Midodrine has less side effects than methoxamine. Such drugs have proven effective, especially when combined with methods such as estrogen or pelvic floor muscle training.
Surgical treatment of stress urinary incontinence
- The main indications for surgery include:
- (1) Patients with poor results of non-surgical treatment or who cannot adhere to, cannot tolerate, and have poor expected results.
- (2) Patients with moderate to severe stress urinary incontinence that seriously affect quality of life.
- (3) Patients with high quality of life requirements.
- (4) Patients with pelvic floor functional lesions such as pelvic organ prolapse and who need pelvic floor reconstruction, should also undergo anti-stress incontinence surgery.
- At present, the transvaginal urethral sling has gradually replaced the traditional open surgery, which has the advantages of less damage and good curative effect. The main methods are TVT, TVT-O, TOT, etc. Complications are mainly urinary retention, bladder injury, sling erosion, etc., but the incidence is very low. [1]
Stress urinary incontinence
- The anatomical structure of the lower urinary tract of men is different from that of women. Spontaneous stress urinary incontinence is extremely rare. It is generally seen after benign prostatic hyperplasia (incidence rate <1%) and after radical prostatectomy (incidence rate 8-40%). Most patients can be relieved after proper pelvic floor muscle training. In severe cases, drugs can be injected under the mucosa of the urethra or male sling surgery, but the effect is not satisfactory.