Stress urinary incontinence

Stress Urinary Incontinence (SUI)

• 50% OF UI in women
• Intrinsic loss of urethral strength and/or
• Urethral hypermobility

Risk factors for female SUI 

• Childbirth
• Ageing
• Oestrogen withdrawal
• Previous pelvic surgery
• Obesity 

Risk factors for male SUI

• EUS damage (pelvic *, RP, Pelvic surgery, Rx) 

Other risk factors 

• Neurological disorders (SCI, MS, Spina bifida) 

Investigation of SUI 

• Women

• Stress test (cough)
• Pad test (no and weight of pads)
• Pelvic exam 
• POP
• Elevation of an existing anterior wall prolapse will unmask any occult sphincter incompetence
• Oestrogen status 
• Q-tip test 
• Lithotomy position 
• Bladder comfortably full 
• Well lubricated sterile cotton-tipped applicator inserted into bladder
• Applicator withdrawn to point of resistance (bladder neck) 
• Resting angle from horizontal recorded 
• Patient asked to strain and the degree of rotation is assessed 
• > 30 degree resting or straining angle from the horizontal defines hypermobility. 
• Urethral pressure profile 
• Urodynamics recommended before surgery for SUI if 
• Suspicion of DO
• Previous surgery for SUI or anterior compartment prolapse 
• Voiding dysfunction 

• Men

• Abdominal exam (palpable bladder) 
• External genitalia exam (penile abnormalities) 
• DRE 
• Flow Rate and PVR 
• Upper tract imaging if BOO 

Treatment of SUI

Conservative treatment 

• PFMT
• Eight contractions, three times per day
• Improves symptoms in 30% of women with mild SUI
• Lifestyle modification
• Weight loss 
• Stop smoking 
• Avoid constipation
• Modify fluid intake 
• Biofeedback
• Info on strength of PF contraction is presented as visual, auditory or tactile signal. 
• Medication
• Duloxetine: inhibits reuptake of both serotonin and noradrenaline increases sphincteric muscle activity during bladder filling. 
• Extracorporal magnetic innervation
• pulsed magnetic field to stimulate the nerves of the sphincter and pelvic floor 
• High frequency electrical stimulation 
• No proven benefit in SUI

Surgical treatment 

• Urethral bulking agents 
• Retropubic suspension 
• Suburethral slings 
• Artificial urinary sphincters