Treatment for stress urinary incontinence

Conservative Treatment:
Conservative measures like proper fluid management and timed voiding are simple and effective ways for patient to regain their bladder control. Patients are asked to avoid excessive fluid intake and also caffeine. Life style adaptations such as weight loss, smoking cessation, avoidance of straining and constipation are also advocated.

Pelvic floor exercise (PFE) is often advocated for patients with mild symptoms or before their consideration for surgery. It entails the voluntary contraction of the pelvic floor muscles. It has been shown that PFE used in conjunction with biofeedback improves the outcome of treatment.

Operative Treatment:
The goals of surgical treatment for stress urinary incontinence (SUI) are to prevent abnormal descent of the urethra that occurs during increases in abdominal pressure and to provide a backboard against which the bladder neck and proximal urethra can be compressed during increase in abdominal pressure. Treatment falls into the following 2 major categories:

(1)     Retropubic suspension
(2)     Sling Procedure

Burch retropubic colposuspension has been considered the gold standard for treatment of SUI due to pelvic floor laxity for almost 40 years.  First described in 1961, it involves the lateral fixation of the urethrovaginal tissue to the Cooper’s ligament. It produces long term durable results. Studies have shown that the success rate is more than 80% even after 10 years.

In the past few years, the use of mid-urethral sling has gained wide popularity. It involves the placement of a tension free synthetic tape to the mid-urethra. It is first introduced by Ulstem in 1996. It is a minimal invasive procedure with short hospital stay. The success rate is more than 80%. Possible complications include prolonged retention, de novo detrusor instability and erosion.