OBJECTIVE: Stress urinary female incontinence (SUI) is primary due to intrinsic sphincter deficiency (ISD) and urethral hypermobility.
Despite a lack of standardised international definition, ISD needs to be clearly diagnosed in order to be correctly treated. This work is an update about the female ISD produced from a review of a published article.
MATERIAL AND METHODS: This review of article published on this subject in the Medline (Pubmed database), selected according to their scientific relevants, of consensus conferences and published guidelines, has been performed by the committee for women pelvic floor surgery of the French Urological Association.
RESULTS: Although there is no international consensus definition, we can consider that the ISD is a composite concept combining urodynamic data (MUCP< 20 or 30cmH20) and one or more clinical information (no urethral mobility, negative urethral support test, failure of a first surgery, leakage during abdominal straining, high stress incontinence scores). Imaging can provide additional evidence for intrinsic sphincter deficiency diagnosis, but the correlation between imaging and function remains low. By standardizing methodology and interpretations to better diagnose women with ISD, it may be possible to improve preoperative planning and outcomes for these patients. A retropubic midurethral sling can be performed as a first surgery. In case of a lack of urethral mobility, the artificial urinary sphincter (AUS) remains the gold standard. Adjustable continence therapy (ACT®) can be proposed as an alternative option. The efficacy and safety of muscle-derived cell therapy in ISD needs more studies. Injection of bulking agents may be an option according to the severity and the expectations of the patient. Bladder overactivity needs to be treated as first-line in case of mixed urinary incontinence. In elderly women, a careful evaluation of the bladder contractility and comorbidity must be performed. A geriatric evaluation can be necessary.
CONCLUSION: Clinical and paraclinical assessment allow to confirm the diagnosis of female ISD, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment.
Written by:
Cour F, Le Normand L, Lapray JF, Hermieu JF, Peyrat L, Yiou R, Donon L, Wagner L, Vidart A. Are you the author?
Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles-Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78035 Versailles cedex, France; Service d'urologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France; Centre de radiologie, 151, avenue de Saxe, 69003 Lyon, France; Service d'urologie, CHU Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France; Service d'urologie, CHU Tenon, 4, rue de la Chine, 75020 Paris, France; Service d'urologie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France; Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Service d'urologie, CHU de Nîmes, place du Pr-Debré, 30065 Nîmes cedex 09, France.
Reference: Prog Urol. 2015 Apr 9. pii: S1166-7087(15)00103-7.
doi: 10.1016/j.purol.2015.03.006
PubMed Abstract
PMID: 25864653