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READING
dr. Indra Wicaksono
 STRESS URINARY
INCONTINENCE
International Continence Society,

involuntary loss of urine that occurs when physical forces on the

bladder are increased during physical movement of the body

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society.  Am J Obstet Gynecol. 2002;187:116–26.
STRESS URINARY
INCONTINECE

Aetiology:
• anatomic defects
• intrinsic sphincter deficiency, with
incontinence
1. Magon N. Gonadotropin releasing hormone agonists: Expanding vistas. Indian J Endocrinol Metab. 2011;15:261–7. [PMC free article] [PubMed] [Google Scholar]
2. Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3–9. [PMC free article] [PubMed] [Google Scholar]
3. Hampel C, Wienhold D, Benken N, Eggersmann C, Thüroff JW. Definition of overactive bladder and epidemiology of urinary incontinence.  Urology. 1997;50(6A Suppl):4–14. discussion 15-7. [PubMed] [Google Scholar]
SYMPTOMS AND SIGN
involuntary leakage of urine on effort or exertion,
or on sneezing or coughing

1. Magon N. Gonadotropin releasing hormone agonists: Expanding vistas. Indian J Endocrinol Metab. 2011;15:261–7. [PMC free article] [
PubMed] [Google Scholar]
2. Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3–9. [PMC free article] [
PubMed] [Google Scholar]
3. Hampel C, Wienhold D, Benken N, Eggersmann C, Thüroff JW. Definition of overactive bladder and epidemiology of urinary
incontinence. Urology. 1997;50(6A Suppl):4–14. discussion 15-7. [PubMed] [Google Scholar]
 RISK FACTOR

Age Race Obesity Menopause

Childbirth Smoking and

and chronic lung Hysterectomy
pregnancy disease
1. Magon N. Gonadotropin releasing hormone agonists: Expanding vistas. Indian J Endocrinol Metab. 2011;15:261–7. [PMC free article] [PubMed] [Google Scholar]
2. Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3–9. [PMC free article] [PubMed] [Google Scholar]
3. Hampel C, Wienhold D, Benken N, Eggersmann C, Thüroff JW. Definition of overactive bladder and epidemiology of urinary incontinence.  Urology. 1997;50(6A Suppl):4–14. discussion 15-7. [PubMed] [Google Scholar]
 PATHOPHYSIOLOGY
The ability to maintain urine storage with convenient and socially
acceptable voluntary emptying is continence

during filling:
• urethral contraction is coordinated with bladder relaxation and urine is stored

during voiding:
• The urethra relaxes and the bladder contracts
1. Magon N. Gonadotropin releasing hormone agonists: Expanding vistas. Indian J Endocrinol Metab. 2011;15:261–7. [PMC free article] [PubMed] [Google Scholar]
2. Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3–9. [PMC free article] [PubMed] [Google Scholar]
3. Hampel C, Wienhold D, Benken N, Eggersmann C, Thüroff JW. Definition of overactive bladder and epidemiology of urinary incontinence.  Urology. 1997;50(6A Suppl):4–14. discussion 15-7. [PubMed] [Google Scholar]
 PATHOPHYSIOLOGY:
PRESSURE TRANSMISSION

1. Magon N. Gonadotropin releasing hormone agonists: Expanding vistas. Indian J Endocrinol Metab. 2011;15:261–7. [PMC free article] [PubMed] [Google Scholar]
2. Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3–9. [PMC free article] [PubMed] [Google Scholar]
3. Hampel C, Wienhold D, Benken N, Eggersmann C, Thüroff JW. Definition of overactive bladder and epidemiology of urinary incontinence.  Urology. 1997;50(6A Suppl):4–14. discussion 15-7. [PubMed] [Google Scholar]
 PATHOPHYSIOLOGY:
URETHRAL SUPPORT
ligaments along the lateral aspects of the urethra, termed the
pubourethral ligaments

the vagina and its lateral fascial condensation

the arcus tendinous fascia pelvic

levator ani muscles

1. Magon N. Gonadotropin releasing hormone agonists: Expanding vistas. Indian J Endocrinol Metab. 2011;15:261–7. [PMC free article] [PubMed] [Google Scholar]
2. Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6(Suppl 3):S3–9. [PMC free article] [PubMed] [Google Scholar]
3. Hampel C, Wienhold D, Benken N, Eggersmann C, Thüroff JW. Definition of overactive bladder and epidemiology of urinary incontinence.  Urology. 1997;50(6A Suppl):4–14. discussion 15-7. [PubMed] [Google Scholar]
TREATMENT
IAUI
INTRODUCTION
Lifetime risk requiring
surgery for stress urinary
incontinence in US

13.5%
INTRODUCTION
Lifetime risk requiring
surgery for stress urinary
incontinence in US

13.5% The Burch

colposuspension
John C Burch in 1961
MID-
URETHR
AL
SLING
METHODS
Type of study
• Cohort

Population
• women with SUI proven on urodynamic studies who had surgery for SUI either by open
abdominal BC or RP-MUS
Outcome
• presence or absence of SUI on follow-up, the success of index surgery based on
response to validated questionnaires of patient-reported outcomes, and retreatment
rates
METHODS
Type of study
• Cohort

Population
• women with SUI proven on urodynamic studies who had surgery for SUI either by open
abdominal BC or RP-MUS
Outcome
Cutt off:
• presence or absence of SUI on follow-up,
ICIQ-UI the
SF ofsuccess
≤6 of index surgery based on
response
Patient to validated
Global Impressionquestionnaires
of Improvementof patient-reported
(PGI-I) of “very much outcomes, and“much
improved” and retreatment
improved
rates
 RESULT
DEMOGRAPHIC
 RESULT
OUTCOME
RESULT: SECONDARY
OUTCOME
RESULT: SECONDARY
OUTCOME
DISCUSSION

Foss Hansen et • 6% re-operation rate for both BC and RP-MUS

al.

• vaginal mesh exposure rates of less than 2.5% and an incidence of

4.5% for chronic pain following RP- MUS
The 2017 • 3-6% after BC and 2-4% after the MUS, The incidence of significant
Cochrane Review persistent voiding dysfunction, particularly needing self-catheterization
beyond 4-6 weeks post-operatively has been reported in the literature
DISCUSSION
BC and MUS approach is likely to be of equal efficacy and safety in
the long-term

MUS as a first-line surgical option 273 to women with ISD

CONCLUSION
This study shows no difference in success, patient satisfaction, or
complications 333 between BC and RP334 MUS