Urinary Stress Incontinence and Current management.

Stress incontinence is an involuntary loss of urine, occurs with an elevation of intra abdominal pressure. Quite often subjects, especially women present with the complaint of urine leakage while on coughing, sneezing etc. This problem is quite prevalent among female population, and the Indian incidence is estimated to be around 12% in women of reproductive age group. Often wrongfully considered a trivial situation, the inconveniences, embarrassment and the health hazards it brings in are disastrous.

The exact pathophysiology of stress incontinence is incompletely understood and deceptively complex. Many theories exist as to how the continence is maintained with an increase in intra-abdominal pressure. A reflex activity of pelvic floor which elevates the proximal urethra, intact connective tissue support of bladder neck and urethra, the action of urethrovaginal sphincter and the compressor urethrae are the main among them.  So, most cases of stress incontinence are believed to be related to damage to the neuromuscular functioning of the pelvic floor, coupled with deficient connective tissue supports of the urethra and bladder neck.

Until recently, even the care givers were at loss, when coming to the management of the condition. We were proposing non-pharmacological measures like Kegel’s exercise and all, just for the reason that the surgical measures available were quite inefficient and carry high morbidity. Pharmacological means were equally disappointing.  It is also interesting to note that, the recent studies on the efficacy of Kegel’s shows that, it is no good as we thought it was!

Now we have Minimally Invasive Sling procedures, which are found to be very effective and the risk of complications are minimal. The entire procedure takes less than 10 minutes and can be performed under a short GA. Now that more companies came up with competitive slings, the procedure has become very cost effective also. Tension free Vaginal tape (TVT) was introduced first, but Transobturator Tape (TOT) is more popular now. The success rate at 1 year were found to be 83- 97% for TOT and 86- 94% for TVT in different studies. The most probable complication is urinary retention, and both the procedures carry a 7-8% risk for that.

(Writeup prepared for the local IMA newsletter)