Stress urinary incontinence (SUI) is a common condition in women. Its true incidence is underestimated because of the tendency of patients to seek specialist advice avoid this problem considered embarrassing.
Clinical manifestation of this condition is the loss of variable amounts of urine in situations that are accompanied by increased intra-abdominal pressure: coughing, sneezing, laughing, lifting, or other physical efforts. Loss of urine is predictable (the patient knows that if he makes a particular effort will lose urine) and prevention (avoidance effort to prevent loss of urine). The higher the amount of urine lost is higher, so the situation is more severe and socially stigmatized.
SUI is associated with defects consistently supportive anatomical structures in the pelvic floor. The mechanism of occurrence of these defects is, on the one hand the poor quality of the connective tissue (like leg varicose veins, hemorrhoids, hernia) and represented by vaginal birth trauma. Causes favorable for the occurrence of urinary stress incontineţei are multiple but most important is a history of vaginal birth and decrease estrogenic hormones after menopause. The greatest increase in risk for women with SUI occurs between one vaginal birth and no birth. The increased risk with each subsequent birth is comparatively small. What is worth noting is that wearing a pregnancy to term, even if the birth is by caesarean section increases the risk of SUI compared with women who had not taken any pregnancy to term.
Along with personal hygiene problems and social, SUI expose patients affected and a number of medical complications: Contact dermatitis (skin after prolonged contact sl of urine irritant area) and the frequent occurrence of urinary tract infections, potentially severe.
Treatment of stress urinary incontinence is essentially surgical and aimed at the restoration / filling enough anatomical support the pelvic floor. Associate and is useful in the preparation of the surgical treatment of hormonal estrogen replacement in the form of eggs that restore the nutrition and muscle urogenital mucosa. Over time, many surgical techniques have been developed to treat SUI, a sign of poor results obtained. After 1990, due to clinical and urodynamic specify the anatomical region to be supported to ensure urinary continence have developed new techniques using implants of biocompatible synthetic materials. These techniques (IVS – intravaginal slingplasty, TVT – tension-free vaginal tape, TOT – transobturator tape) assume prosthesis using bands – synthetic hairpieces, typically polypropylene middle portion of the urethra. Interventions are perfectly standardized and can be done in an outpatient basis. Patient recovery is fast and does not involve long polling bladder surgery. The success rate of the operation expressed as a percentage of postoperative urinary continence patients is between 85-92%.
Complications that may occur from use of these techniques – bleeding, gastrointestinal, urethral erosion and rejection are minimal, almost non-existent for TOT technique.
The excellent results of these innovative techniques impose as first choice in the treatment of stress urinary incontinence in women.
Dr. Alina Ursuleanu, Obstetrics and Gynecology, Assistant Professor, Doctor of Medicine