Rigi10™ Malleable Penile Prosthesis
Also Known As
Stress Incontinence, SUI, Activity-Related Incontinence, Effort Incontinence.
Definition
Stress Urinary Incontinence (SUI) is a common urological condition characterized by the involuntary leakage of urine during activities that increase intra-abdominal pressure.¹ It occurs when physical movement or activity — such as coughing, sneezing, laughing, running, or heavy lifting — puts pressure (stress) on the bladder, leading to urine leakage.² SUI is not related to psychological stress. The underlying mechanism involves a failure of the urethral closure mechanism to maintain continence under these pressure conditions. Normally, the urethra, the tube that carries urine out of thebody, remains closed when abdominal pressure rises, preventing urine leakage. This closure is maintained by the intrinsic urethral sphincter (muscles controlling urine release) and the supportive structures of the pelvic floor.¹² In SUI, these support systems are weakened or damaged, leading to either urethral hypermobility (where the urethra moves downward during stress, preventing proper closure) or intrinsic sphincter deficiency (ISD), where the sphincter itself is unable to close effectively.¹ SUI is significantly more prevalent in women, often linked to factors like childbirth and menopause, but can also affect men, commonly after prostate surgery.¹² The condition can range from occasional, minor leaks to more frequent and substantial leakage, significantly impacting an individual’s quality of life by causing embarrassment and leading to limitations in social, work, and physical activities.²
Clinical Context
Stress Urinary Incontinence (SUI) is clinically relevant when patients report involuntary urine leakage triggered by physical exertion such as coughing, sneezing, laughing, exercising, or lifting heavy objects.¹² The diagnosis typically begins with a detailed medical history, including voiding patterns (often aided by a voiding diary), obstetric history, previous surgeries, and the impact of leakage on quality of life.¹ A physical examination is crucial, which in women includes a pelvic exam to assess for pelvic organ prolapse, pelvic floor muscle strength, and to directly observe urine leakage during a cough stress test.¹ The Q-tip test may be used to assess urethral hypermobility.¹ Post-void residual (PVR) urine volume measurement helps rule out incomplete bladder emptying.¹ Urinalysis is performed to exclude urinary tract infection or other bladder pathologies.¹
Urodynamic testing is not routinely indicated for uncomplicated SUI but may be considered in complex cases, such as when the diagnosis is uncertain, if there’s a history of previous incontinence surgery, significant pelvic organ prolapse, or symptoms suggestive of mixed incontinence (SUI and urge incontinence).&sup4; Relevant urodynamic parameters include Valsalva leak point pressure (VLPP) and maximum urethral closure pressure (MUCP) to differentiate between urethral hypermobility and intrinsic sphincter deficiency (ISD).¹ ISD is characterized by a poorly functioning urethral sphincter, often indicated by a VLPP <60 cm H2O or MUCP <20 cm H2O.¹
Patient selection criteria for treatment depend on the severity of SUI, its impact on the patient’s life, patient preferences, and overall health. Conservative management is often the first line of treatment and includes lifestyle modifications (e.g., weight loss for obese patients, fluid management, smoking cessation), pelvic floor muscle training (Kegel exercises), with or without biofeedback, and bladder retraining.¹² Mechanical devices like pessaries or urethral inserts can be used in some women.¹
Surgical procedures are considered when conservative measures fail or are not preferred by the patient. Common surgical options for women include:³
- Mid-urethral slings (MUS): These are the most common surgical treatment. A synthetic mesh tape is placed under the urethra to provide support. Types include retropubic slings (e.g., TVT) and transobturator slings (e.g., TOT).¹³
- Autologous fascial slings: These use the patient’s own tissue (fascia) to create a sling, often preferred in cases of recurrent SUI or concerns about synthetic mesh.¹³
- Urethral bulking agents: Injectable materials are used to add bulk to the urethral walls, improving closure. This is less invasive but may be less durable.¹³
- Artificial Urinary Sphincter (AUS): This is considered the gold standard for severe SUI, particularly in men after prostatectomy, and sometimes in women with complex SUI. It involves implanting a device with an inflatable cuff around the urethra.&sup6;
Expected outcomes vary by treatment. Pelvic floor muscle training can significantly improve or cure SUI in many women, especially with mild to moderate symptoms. Surgical interventions like slings and AUS generally have high success rates (often defined as significant reduction in leakage or complete dryness) in appropriately selected patients.¹³ However, potential complications exist for all treatments, including pain, infection, voiding dysfunction, mesh-related complications for synthetic slings, or mechanical failure for AUS.¹ Patient counseling regarding realistic expectations, benefits, and risks of each option is essential.³