Reply to Letter to the Editor by Dr. Petros about “The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis”

Excerpt

We thank Dr. Petros for his interest in our recent publication, “The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis” [1]. This was an extensive review that included peer-reviewed manuscripts reporting on anatomical, physiological, and functional differences between women with signs and/or symptoms consistent with stress urinary incontinence (SUI) and a concurrently recruited control group of women without signs or symptoms SUI or other substantive urogynecological symptoms. Of 4,629 publications screened, 84 met the inclusion criteria and were retained. The main finding arising from the synthesis is that SUI is multifactorial—with evidence pointing to deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS), and levator ani muscle structure and function all being associated with SUI. Meta-analyses showed that bladder neck dilation, smaller functional urethral length, less bladder neck support, and smaller maximum urethral closure pressure are strong characteristic signs of SUI. …