Vaginal Tapes For Surgical Treatment Of Stress Urinary Incontinence

Abstract

Stress incontinence is defined as the involuntary loss of urine during any physic.al exertion as c.oughing, sneezing, lifting heavy weights or even bearing down. It is often seen in women after middle of age usually as a result of weakness of the pelvic floor and poor support of the vesicourethral sphincteric unit (Petros et al, 1997).

SlJI in females is caused either by anatomic malposition of the urethra and bladder neck ( anatomical type ) or caused by intrinsic sphincter dysfunction ( sphincteric type ).

Continence m the female normally reqmres the effective transmission of intra abdominal pressure lo the urethra, and adequate functional urethral length and closing pressure and the correct location of the sphincteric unit. (Little, 1989).

The initial evaluation of the female >vith urinary incontinence should begin with a through history including parity, previous pelvic surgery, pattern, frequency, severity of incontinence and associated urgency and urge incontinence . physical examination of the patient should include stress test, Marshall Marchetti and Bonney tests.

Pelvic examination is also important to exclude cystocele or rectocele. Cystourethrography provides an excellent tool to objectively assess anatomic defects , bladder neck and urethral status. If the history, physical findings and cystourethrography are all consistent with SUI, urodynamic evaluation may be unnecessary. However, if the history is not clear , or in the presence of mixed incontinence, urodynamic evaluation is essential.