Pathophysiology of genuine stress incontinence: what do we really know?

Excerpt

Many theories have been proposed to explain why women develop genuine stress incontinence. Currently the most accepted theory divides cases into either anatomic stress incontinence or what has been termed intrinsic sphincter deficiency. What scientific support do we have that this classification is an accurate depiction of why women develop stress urinary incontinence (SUI)? In 1949 Marshall, Marchetti and Krantz discovered that if you suspend the proximal urethra from the back of the symphysis many women with stress incontinence become dry [1]. Retropubic suspensions have been very successful for the correction of SUI, and so it has been assumed that as the procedure stabilizes the proximal urethra, urethral mobility must be the major culprit. Theories such as pressure transmission ratios were then developed to help explain why continence occurred after suspension procedures. Over the last few years a new procedure has evolved that involves the placement of a synthetic sling under the midportion of the urethra. Preliminary literature would seem to indicate that this procedure, in regards to restoring continence, is as efficacious as more traditional procedures [2]. These procedures neither support nor suspend the proximal urethra or bladder neck. …